Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A301420 | CA |
N | 111NI0900X | Internist | A301420 | CA |
Y | 207RN0300X | Nephrologist | A301420 | CA |
NPI | 1013902733 |
---|---|
Provider Name | Dr. David J Heaney |
First Address | Visalia, CA 93291-6131 |
Second Address | Visalia, CA 93291-6131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A301420 | (05) | CA |
05D0864240 | CLIA NUMBER (01) | CA |
1013123686 | NPPES-TULARE LOCATION (01) | CA |
1588879175 | NPPES-VISALIA LOCATION (01) | CA |
1972710127 | NPPES-PORTERVILLE LOC. (01) | CA |
942512154 | FED TAX ID # (01) | CA |
A25982 | (02) | CA |
A30142 | CALIF. MEDICAL BOARD (01) | CA |