Healthcare Provider Details

I. General information

NPI: 1912919200
Provider Name (Legal Business Name): JAMES M HEAPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ STE 383
LOS ANGELES CA
90024-6992
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-983-1023
  • Fax: 310-983-1034
Mailing address:
  • Phone: 310-983-1023
  • Fax: 310-983-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG53039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: