Provider Demographics
NPI:1447581566
Name:MACBRAIR, HEATHER (RD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MACBRAIR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MODESTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:6215 FERAL AVE
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1756
Mailing Address - Country:US
Mailing Address - Phone:818-540-8269
Mailing Address - Fax:
Practice Address - Street 1:6215 FERAL AVE
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1756
Practice Address - Country:US
Practice Address - Phone:818-540-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD972811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist