MEDICARE: MR. LEROY Y. M. HEU A.T.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1265477020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEROY Y. M. HEU A.T.C.

Provider Business Mailing Address
First Line	:	PO BOX 1851
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93116-1851
Country	:	US
Telephone Number	:	805-893-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 OCEANO AVE
Second Line	:	ICA BUILDING UCSB
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-2214
Country	:	US
Telephone Number	:	805-893-3424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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