MEDICARE: MRS. HEATHER C HEROLD PA-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	363A00000X	Physician Assistant	PA20599	CA

General Provider Information

NPI Number	:	1295066223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER C HEROLD PA-C

Provider Business Mailing Address
First Line	:	801 E KATELLA AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-6614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 W LINCOLN AVE STE 105
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-2928
Country	:	US
Telephone Number	:	714-922-1004
Fax Number	:

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	07/17/2023

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