Healthcare Provider Details

I. General information

NPI: 1265477020
Provider Name (Legal Business Name): LEROY Y. M. HEU A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OCEANO AVE ICA BUILDING UCSB
SANTA BARBARA CA
93109-2214
US

IV. Provider business mailing address

PO BOX 1851
GOLETA CA
93116-1851
US

V. Phone/Fax

Practice location:
  • Phone: 805-893-3424
  • Fax:
Mailing address:
  • Phone: 805-893-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: