Healthcare Provider Details

I. General information

NPI: 1205880994
Provider Name (Legal Business Name): ABSALOM D HEPNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3570
  • Fax: 949-364-3430
Mailing address:
  • Phone: 949-364-3570
  • Fax: 949-364-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA78126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: