Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G45263 | CA |
N | 111NI0900X | Internist | G45263 | CA |
Y | 207RN0300X | Nephrologist | G45263 | CA |
NPI | 1013029487 |
---|---|
Provider Name | Dr. Avi J Hettena |
First Address | Rancho Santa Fe, CA 92067-7281 |
Second Address | Rancho Santa Fe, CA 92067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G452630 | (05) | CA |
110017611 | MEDICARE RAILROAD (01) | CA |
A49961 | (02) | CA |