Doctor Name: | DR. HEIDI C MIST |
NPI Number: | 1154461416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD, MPH&TM |
License Number: | A80054 |
Business Practice Address: | 1022 Jefferson St Red Bluff, CA - 960802726 |
Business Phone Number: | 5305277333 |
Business Fax Number: | 5305277300 |
Mailing Address: | 1022 Jefferson St, RED BLUFF |
State: | CA |
Postal Code: | 960802726 |
Phone Number: | 5305277333 |
Fax Number: | 5305277300 |
NPI Enumeration Date: | 02/07/2007 |
NPI Last Update Date: | 08/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A80054 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |