Healthcare Provider Details

I. General information

NPI: 1780595223
Provider Name (Legal Business Name): HEATHER WAKEFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 RUFFIN RD
SAN DIEGO CA
92123-1313
US

IV. Provider business mailing address

5454 RUFFIN RD
SAN DIEGO CA
92123-1313
US

V. Phone/Fax

Practice location:
  • Phone: 858-271-1414
  • Fax:
Mailing address:
  • Phone: 858-271-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250040349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: