Provider Demographics
NPI:1548901234
Name:HEISE, FLECICIA DEON
Entity type:Individual
Prefix:
First Name:FLECICIA
Middle Name:DEON
Last Name:HEISE
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 1:1786 AVENIDA ALTA MIRA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6507
Mailing Address - Country:US
Mailing Address - Phone:760-744-1150
Mailing Address - Fax:
Practice Address - Street 1:1140 W MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1487
Practice Address - Country:US
Practice Address - Phone:760-744-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer