Provider Demographics
NPI:1922573211
Name:LANDINGHAM, HEATHER MAUREEN
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAUREEN
Last Name:LANDINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MAUREEN
Other - Last Name:JOSHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4545 GEORGETOWN PL STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6229
Mailing Address - Country:US
Mailing Address - Phone:209-955-1139
Mailing Address - Fax:209-955-1143
Practice Address - Street 1:4545 GEORGETOWN PL STE D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6229
Practice Address - Country:US
Practice Address - Phone:209-269-5587
Practice Address - Fax:209-230-9798
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker