Doctor Name: | DR. COLLEEN TAMARA HIEBENTHAL |
NPI Number: | 1538396064 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 01068513A |
Business Practice Address: | Uss Comstock Lsd 45 Fpo, AP - 966621733 |
Business Phone Number: | 6195563845 |
Business Fax Number: | |
Mailing Address: | 530 K St, #203 SAN DIEGO |
State: | CA |
Postal Code: | 921017058 |
Phone Number: | 5042376546 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2009 |
NPI Last Update Date: | 08/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01068513A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |