Provider Demographics
NPI:1336986942
Name:TYNAN, HEATHER (ND, DACM)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:TYNAN
Suffix:
Gender:F
Credentials:ND, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11169 PEGASUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4717
Mailing Address - Country:US
Mailing Address - Phone:973-862-3046
Mailing Address - Fax:
Practice Address - Street 1:11169 PEGASUS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4717
Practice Address - Country:US
Practice Address - Phone:858-522-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1251175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath