Provider Demographics
NPI:1437990512
Name:POE, HEATHER CHERI
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHERI
Last Name:POE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24813 NARBONNE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1593
Mailing Address - Country:US
Mailing Address - Phone:310-408-3578
Mailing Address - Fax:
Practice Address - Street 1:24813 NARBONNE AVE APT 103
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1593
Practice Address - Country:US
Practice Address - Phone:310-408-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility