Healthcare Provider Details

I. General information

NPI: 1184125999
Provider Name (Legal Business Name): HEATHER MARIE NDIMA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CHERRY RIDGE ST
SAN ANTONIO TX
78230-4823
US

IV. Provider business mailing address

6526 CANDLECANE CIR
SAN ANTONIO TX
78244-1914
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-0222
  • Fax:
Mailing address:
  • Phone: 210-760-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number322304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: