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NPI Code Detail

MEDICARE: HEIDI MIZE

MEDICARE: HEIDI MIZE
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
1103TS0200XSchool PsychologistCA

General Provider Information

NPI Number : 1912866906
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI MIZE
Provider Business Mailing Address
First Line : 1000 YULUPA AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-7020
Country : US
Telephone Number : 707-539-9665
Fax Number :
Provider Business Practice Location Address
First Line : 1000 YULUPA AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-7020
Country : US
Telephone Number : 707-539-9665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “ HEIDI MIZE ” Practice Location

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