Provider Demographics
NPI:1124737531
Name:KLEIN, HEATHER R (CRNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RYAN
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:13135 E MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2144
Mailing Address - Country:US
Mailing Address - Phone:805-208-9634
Mailing Address - Fax:
Practice Address - Street 1:13651 WILLARD ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-375-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001880367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered