Provider Demographics
NPI:1518000546
Name:COLBERT, HEATHER A (MD, PHD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 PARKER COURT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043
Mailing Address - Country:US
Mailing Address - Phone:650-625-9898
Mailing Address - Fax:
Practice Address - Street 1:2221 ENBORG LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2608
Practice Address - Country:US
Practice Address - Phone:408-885-6220
Practice Address - Fax:408-885-3977
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA792692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF427YMedicare PIN
CA00A792691Medicare PIN