| Organization Name: | HERITAGE CLINIC PALMDALE |
| NPI Number: | 1023234747 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VATCHE KELARTINIAN (CFO) |
| Mailing Address: | 1037 W Avenue N Suite 205 Palmdale |
| State: | CA US |
| Postal Code: | 935512002 |
| Phone Number: | 6615759365 |
| Fax Number: | 6615759502 |
| NPI Enumeration Date: | 04/18/2007 |
| NPI Last Update Date: | 10/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY19717 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |