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General NPI Number Information
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NPI Number | 1982960514
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Entity Type | Individual
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Provider Name | HEIDI DEYRO
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Gender | Female
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2160 S. FIRST AVENUE
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-216-3282
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Fax |
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Provider Business Mailing Address
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Address Line | 393 E WALNUT ST FL 3
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City | PASADENA
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State | CA
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Zip | 91188-0001
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A133814
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License Number State | CA
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