Provider Demographics
NPI:1124744248
Name:FLORIANI, HEATHER ANDREA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANDREA
Last Name:FLORIANI
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 1:1754 PORT MANLEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6622
Mailing Address - Country:US
Mailing Address - Phone:650-274-4919
Mailing Address - Fax:
Practice Address - Street 1:1754 PORT MANLEIGH CIR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6622
Practice Address - Country:US
Practice Address - Phone:650-274-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist