Healthcare Provider Details

I. General information

NPI: 1235750464
Provider Name (Legal Business Name): MS. YAEL HEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LINCOLN AVE STE 201
SAN RAFAEL CA
94901-2142
US

IV. Provider business mailing address

1330 LINCOLN AVE STE 201
SAN RAFAEL CA
94901-2142
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-5999
  • Fax:
Mailing address:
  • Phone: 415-459-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: