Healthcare Provider Details

I. General information

NPI: 1336484781
Provider Name (Legal Business Name): NANCY M HEJDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY M HEJDE PA-C

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S SEASIDE AVE
SAN PEDRO CA
90731-7333
US

IV. Provider business mailing address

1001 S SEASIDE AVE
SAN PEDRO CA
90731-7333
US

V. Phone/Fax

Practice location:
  • Phone: 310-521-6053
  • Fax:
Mailing address:
  • Phone: 310-521-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9107870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: