Provider Demographics
NPI:1023438900
Name:BEDIENT, HEATHER L (LAC,DIPL OM, CMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:BEDIENT
Suffix:
Gender:F
Credentials:LAC,DIPL OM, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2413
Mailing Address - Country:US
Mailing Address - Phone:310-592-4986
Mailing Address - Fax:
Practice Address - Street 1:1905 PALMETTO AVE STE D
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2573
Practice Address - Country:US
Practice Address - Phone:415-758-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16062171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist