Healthcare Provider Details

I. General information

NPI: 1609425255
Provider Name (Legal Business Name): STACEY M. HEIN MD. APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

15215 NATIONAL AVE STE 200
LOS GATOS CA
95032-2425
US

IV. Provider business mailing address

15215 NATIONAL AVE STE 200
LOS GATOS CA
95032-2425
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1841
  • Fax: 408-356-6970
Mailing address:
  • Phone: 408-358-1841
  • Fax: 408-356-6970

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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY M HEIN
Title or Position: PROVIDER
Credential: MD
Phone: 408-358-1841