Healthcare Provider Details

I. General information

NPI: 1831346352
Provider Name (Legal Business Name): HECTOR HEREDIA, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 H ST SUITE 5
CHULA VISTA CA
91910-4321
US

IV. Provider business mailing address

401 H ST SUITE 5
CHULA VISTA CA
91910-4321
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-1010
  • Fax:
Mailing address:
  • Phone: 619-420-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HECTOR HEREDIA-MARTINEZ
Title or Position: PROVIDER
Credential: MD
Phone: 619-420-1010