Healthcare Provider Details

I. General information

NPI: 1700984911
Provider Name (Legal Business Name): RICHARD PAUL HEIDENFELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

1115 STRATFORD AVE
SOUTH PASADENA CA
91030-3417
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-8918
  • Fax:
Mailing address:
  • Phone: 619-435-4088
  • Fax: 619-435-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA79836
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA79836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: