Provider Demographics
NPI:1992929335
Name:TAWADROS, HEIDI (PAC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:TAWADROS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3101
Mailing Address - Country:US
Mailing Address - Phone:323-562-2535
Mailing Address - Fax:323-562-2558
Practice Address - Street 1:5920 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3101
Practice Address - Country:US
Practice Address - Phone:323-562-2535
Practice Address - Fax:323-562-2558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14409208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice