Healthcare Provider Details

I. General information

NPI: 1871406660
Provider Name (Legal Business Name): ABIGAIL HEASLET
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL STE 220
OCEANSIDE CA
92054-6376
US

IV. Provider business mailing address

100 MAIN ST APT 432
VISTA CA
92084-6070
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 623-910-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: