MEDICARE: CARLY HEFT CSFA

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	246ZC0007X	Surgical Assistant	152261	AZ

General Provider Information

NPI Number	:	1396153086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY HEFT CSFA

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-0938
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	5363 N SABINO CANYON RD #11
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-7089
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

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

Provider Enumeration Date	:	07/26/2014
Last Update Date	:	09/05/2019

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Directions to “ CARLY HEFT CSFA” Practice Location

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