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General NPI Number Information
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NPI Number | 1326437492
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Entity Type | Organization
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Legal Business Name | HEIDI A HEROLD, MD INC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 2143 AIRPARK DR
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City | REDDING
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State | CA
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Zip | 96001-2447
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Country | US
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Telephone | 530-241-7477
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Fax | 530-241-7877
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Provider Business Mailing Address
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Address Line | 2143 AIRPARK DR
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City | REDDING
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State | CA
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Zip | 96001-2447
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Country | US
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Telephone | 530-241-7477
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Fax | 530-241-7877
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUSIE J JENSEN
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Credential |
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Telephone | 530-241-7477
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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 | A86057
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License Number State | CA
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