1467885764 NPI number — KURT A HEINER MD

Table of content: MELANIE ANNE VININGAUZ MA CCC-SLP (NPI 1518614114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467885764 NPI number — KURT A HEINER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINER
Provider First Name:
KURT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467885764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1990NORTH CALIFORNIA BLVD, STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-482-8249
Provider Business Mailing Address Fax Number:
650-685-8230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 OAK GROVE AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-796-9330
Provider Business Practice Location Address Fax Number:
650-685-8230
Provider Enumeration Date:
08/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  C41094 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C41094 . This is a "STATE OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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