Provider Demographics
NPI:1174698880
Name:HEIDEL, STEPHEN H (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:HEIDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3252 HOLIDAY CT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:858-759-8321
Mailing Address - Fax:858-756-9417
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 205
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-759-8321
Practice Address - Fax:858-756-9417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG303742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G303740Medicaid
CA00G303740Medicaid