Provider Demographics
NPI:1811937683
Name:HOULIHAN, HEIDI ELLEN (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ELLEN
Last Name:HOULIHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0207
Mailing Address - Country:US
Mailing Address - Phone:530-895-1727
Mailing Address - Fax:530-895-1506
Practice Address - Street 1:3401 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0207
Practice Address - Country:US
Practice Address - Phone:530-895-1727
Practice Address - Fax:530-895-1506
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87124207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A871240Medicaid
BH8865606OtherDEA
CA00A871240Medicaid
I09539Medicare UPIN