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NPI Code Detail

MEDICARE: MEREDITH L HEIDENFELD PA-C

MEDICARE: MEREDITH L HEIDENFELD 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
1363A00000XPhysician AssistantPA2004-0013NM
2363AM0700XMedical Physician AssistantPA2004-0013NM
3363A00000XPhysician Assistant54355CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417954108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH L HEIDENFELD PA-C
Provider Business Mailing Address
First Line : 150 VALPREDA RD
Second Line :
City : SAN MARCOS
State : CA
Zip : 92069-2973
Country : US
Telephone Number : 760-736-6703
Fax Number : 760-736-8740
Provider Business Practice Location Address
First Line : 150 VALPREDA RD
Second Line :
City : SAN MARCOS
State : CA
Zip : 92069-2973
Country : US
Telephone Number : 760-736-6767
Fax Number : 760-736-8740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/21/2022

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