Healthcare Provider Details

I. General information

NPI: 1386732915
Provider Name (Legal Business Name): MAURICIO J. HEILBRON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE SUITE 1002
LONG BEACH CA
90813-3408
US

IV. Provider business mailing address

1045 ATLANTIC AVE SUITE 1002
LONG BEACH CA
90813-3408
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-5511
  • Fax: 562-435-7503
Mailing address:
  • Phone: 562-435-5511
  • Fax: 562-435-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberGO82239
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberGO82239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: