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General NPI Number Information
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NPI Number | 1912398025
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Entity Type | Individual
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Provider Name | KASAUNDRA RAE HEIBERGER PA-C, MPH
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Gender | Female
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1310 CLUB DR
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City | VALLEJO
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State | CA
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Zip | 94592-1187
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Country | US
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Telephone | 707-638-5856
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 CLUB DR STE 215
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City | VALLEJO
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State | CA
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Zip | 94592-1189
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Country | US
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Telephone | 707-638-5856
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA09245
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 85005641
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 56396
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License Number State | CA
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