Individual
HEIDI YVONNE FANTASIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
333 1ST ST STE A, SAN FRANCISCO, CA 94105-2661
(313) 505-0112
Mailing address
5516 BILBAO PL, SARASOTA, FL 34238-4708
(313) 505-0112
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
822836
CA
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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