Healthcare Provider Details

I. General information

NPI: 1639948649
Provider Name (Legal Business Name): HEATHER TAPIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14906 PARAMOUNT BLVD
PARAMOUNT CA
90723-3409
US

IV. Provider business mailing address

3168 LIVE OAK ST
HUNTINGTON PARK CA
90255-6108
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: