Basic Information
| Provider Information | |||||||||
| NPI: | 1174121867 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEAL DOCTORS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 PALISADES DR UNIT 176 | ||||||||
| Address2: | |||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902722844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446444325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 MCCULLOUGH DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282621336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446444325 | ||||||||
| FaxNumber: | 4246250010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2020 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUA | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNWE | ||||||||
| AuthorizedOfficialTelephone: | 8446444325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.