Most Relevant Information
Provider Data
| NPI Number: | 1003519323 |
| Provider Name: | KELLY LORENE HEIMDAHL |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/24/2023 |
| Last Updated: | 03/24/2023 |
Provider Practice Location
23701 E EAST FORK RD
AZUSA
CA
917021477
Practice Location Phone/Fax
| Phone: | 6262503290 |
| Fax: | 6269101380 |
Provider Mailing Location
23701 E EAST FORK RD
AZUSA
CA
917021477
Provider Mailing Phone/Fax
| Phone: | 6262503290 |
| Fax: | 6269101380 |