Individual
HEIDI VIVIAN CIPOLLONE HERRERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25500 RANCHO NIGUEL RD STE 110, LAGUNA NIGUEL, CA 92677-7373
(949) 448-8821
(949) 448-8831
Mailing address
24422 AVENIDA DE LA CARLOTA STE 300, LAGUNA HILLS, CA 92653-3628
(949) 599-2434
(949) 599-2430
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A122576
CA
2080T0002X
Pediatric Medical Toxicology Physician
A122576
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001370800
—
FL
01
—
CH859Z
MEDICARE PTAN
FL
Enumeration date
07/02/2009
Last updated
04/11/2022
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