Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G66486 | CA |
NPI | 1053321000 |
---|---|
Provider Name | James A. Heinrich |
First Address | Mission Viejo, CA 92691-8000 |
Second Address | Mission Viejo, CA 92691-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F56901 | (02) | CA |