Provider Demographics
NPI:1124718176
Name:NOEMI, HEATHER J
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:NOEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S KNOLL RD APT 13
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2453
Mailing Address - Country:US
Mailing Address - Phone:415-888-9410
Mailing Address - Fax:
Practice Address - Street 1:2000 VAN NESS AVE STE 706
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3015
Practice Address - Country:US
Practice Address - Phone:415-317-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist