Basic Information
| Provider Information | |||||||||
| NPI: | 1003142886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 VIA VERDE | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917734400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095929778 | ||||||||
| FaxNumber: | 9095996126 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 VIA VERDE | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917734400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095929778 | ||||||||
| FaxNumber: | 9095996126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2009 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 20A10617 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.