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General NPI Number Information
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NPI Number | 1114390465
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Entity Type | Individual
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Provider Name | HEIDI LEANN MCCULLY
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Gender | Female
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 55 W SIERRA MADRE BLVD STE 200
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2467
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Country | US
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Telephone | 626-708-3391
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Fax | 626-351-1682
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Provider Business Mailing Address
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Address Line | 1260 REXFORD AVE
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City | PASADENA
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State | CA
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Zip | 91107-1614
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Country | US
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Telephone | 626-708-8384
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Fax | 626-351-1682
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 450
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License Number State | CA
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