Healthcare Provider Details

I. General information

NPI: 1740296284
Provider Name (Legal Business Name): RICHARD RAYMOND HEIMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W DUARTE RD
ARCADIA CA
91007-7601
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-4714
  • Fax: 626-445-1701
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG42889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: