Provider Demographics
NPI:1790659381
Name:HEAP, BRETT
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HEAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400113
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0113
Mailing Address - Country:US
Mailing Address - Phone:949-300-5485
Mailing Address - Fax:
Practice Address - Street 1:1801 AVE PONCE DE LEON STE 403
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1917
Practice Address - Country:US
Practice Address - Phone:949-417-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No183700000XPharmacy Service ProvidersPharmacy Technician