Organization Name: | DR HEIDI C MIST MD INC |
NPI Number: | 1912256314 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEIDI MIST (OWNER) |
Mailing Address: | 1022 Jefferson St Red Bluff |
State: | CA US |
Postal Code: | 960802726 |
Phone Number: | 5305277333 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2012 |
NPI Last Update Date: | 10/26/2012 |
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: |