Individual
HEIDI A VONDERHEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7471 N FRESNO ST, FRESNO, CA 93720-2457
(559) 436-4500
(559) 261-1526
Mailing address
7471 N FRESNO ST, FRESNO, CA 93720-2457
(559) 436-4500
(559) 261-1526
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA19674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09029096
—
MS
01
—
GR0043790
MEDICAL ID FOR BAZ ALLERGY ASTHMA & SINUS CENTER
CA
01
—
ZZZ21572Z
GROUP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER
CA
Enumeration date
06/21/2007
Last updated
03/28/2016
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