Healthcare Provider Details

I. General information

NPI: 1518911908
Provider Name (Legal Business Name): OLE A. HEGGENESS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8255 FIRESTONE BLVD STE 500
DOWNEY CA
90241
US

IV. Provider business mailing address

8255 FIRESTONE BLVD STE 500
DOWNEY CA
90241-4858
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-2470
  • Fax: 562-231-2479
Mailing address:
  • Phone: 562-231-2470
  • Fax: 562-231-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: