Healthcare Provider Details

I. General information

NPI: 1750427191
Provider Name (Legal Business Name): RONALD HARVEY HEUBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4614
US

IV. Provider business mailing address

PO BOX 414
VACAVILLE CA
95696-0414
US

V. Phone/Fax

Practice location:
  • Phone: 925-229-7713
  • Fax:
Mailing address:
  • Phone: 415-820-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY6254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: