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General NPI Number Information
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NPI Number | 1356019921
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Entity Type | Individual
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Provider Name | HEIDI R WALDORF FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 751 MEDICAL CENTER CT
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City | CHULA VISTA
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State | CA
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Zip | 91911-6617
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Country | US
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Telephone | 619-502-5990
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Fax |
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Provider Business Mailing Address
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Address Line | 1353 THUNDERBIRD PL
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City | CHULA VISTA
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State | CA
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Zip | 91915-2219
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Country | US
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Telephone | 619-940-4494
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Fax | 619-492-0373
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN95145118
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95022587
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License Number State | CA
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