Healthcare Provider Details

I. General information

NPI: 1497182497
Provider Name (Legal Business Name): HENG MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PASEO CAMARILLO SUITE 100
CAMARILLO CA
93010-5900
US

IV. Provider business mailing address

500 PASEO CAMARILLO SUITE 100
CAMARILLO CA
93010-5900
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-1033
  • Fax: 805-482-7213
Mailing address:
  • Phone: 805-484-1033
  • Fax: 805-482-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MADALENE HENG
Title or Position: DERMATOLOGIST
Credential: M.D.
Phone: 805-484-1033