Provider Demographics
NPI:1154798908
Name:CEVALLOS, HEIDI Z (PHARMD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:Z
Last Name:CEVALLOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W BEECH ST UNIT 434
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2970
Mailing Address - Country:US
Mailing Address - Phone:317-281-5662
Mailing Address - Fax:
Practice Address - Street 1:1988 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6026
Practice Address - Country:US
Practice Address - Phone:760-295-2625
Practice Address - Fax:760-295-2655
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist