Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | GO82239 | CA |
N | 2086S0129X | Vascular Surgeon | GO82239 | CA |
NPI | 1386732915 |
---|---|
Provider Name | Mauricio J. Heilbron JR. |
First Address | Long Beach, CA 90813-3408 |
Second Address | Long Beach, CA 90813-3408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71669 | (02) | CA |