Healthcare Provider Details

I. General information

NPI: 1609166487
Provider Name (Legal Business Name): HEATHER M. SHUMWAY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N MAIN ST
SANTA ANA CA
92701-2304
US

IV. Provider business mailing address

1400 N MAIN ST
SANTA ANA CA
92701-2304
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 714-456-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: