Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003844 | DE |
NPI | 1174969463 |
---|---|
Provider Name | Mr. Jason Heinzeroth |
First Address | Monterey, CA 93940-4518 |
Second Address | Monterey, CA 93940-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 24/04/2014 |