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General NPI Number Information
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NPI Number | 1093764938
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Entity Type | Organization
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Legal Business Name | HERITAGE TECHNOLOGIES, LLC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1855 N STAPLEY DR
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City | MESA
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State | AZ
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Zip | 85203-3002
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Country | US
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Telephone | 480-834-7546
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Fax | 480-833-8313
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Provider Business Mailing Address
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Address Line | 1855 N STAPLEY DR
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City | MESA
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State | AZ
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Zip | 85203-3002
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Country | US
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Telephone | 480-834-7546
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Fax | 480-833-8313
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE DINSDALE
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Credential |
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Telephone | 480-834-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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