Healthcare Provider Details

I. General information

NPI: 1134426208
Provider Name (Legal Business Name): HEATHER FLEHARTY WARREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 EDITH AVE STE B
REDDING CA
96001
US

IV. Provider business mailing address

2656 EDITH AVE STE B
REDDING CA
96001
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-2882
  • Fax: 530-244-3703
Mailing address:
  • Phone: 530-244-2882
  • Fax: 530-244-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA113292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: