Provider Demographics
NPI:1154963940
Name:MCMAHAN, HEIDI (RD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 GRAND AVE
Mailing Address - Street 2:UNIT 5552
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93005-7036
Mailing Address - Country:US
Mailing Address - Phone:425-501-6670
Mailing Address - Fax:
Practice Address - Street 1:5755 VALENTINE RD STE 201
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7456
Practice Address - Country:US
Practice Address - Phone:805-665-3180
Practice Address - Fax:805-256-6081
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86097647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered