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General NPI Number Information
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NPI Number | 1790659381
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Entity Type | Individual
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Provider Name | BRETT HEAP
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Gender | Male
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1801 AVE PONCE DE LEON STE 403
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City | SAN JUAN
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State | PR
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Zip | 00909-1917
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Country | US
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Telephone | 949-417-6888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 400113
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City | LAS VEGAS
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State | NV
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Zip | 89140-0113
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Country | US
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Telephone | 949-300-5485
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Fax |
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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 | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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