Healthcare Provider Details

I. General information

NPI: 1386954030
Provider Name (Legal Business Name): JAMES A HEINRICH M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8000
US

IV. Provider business mailing address

26730 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8000
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2440
  • Fax: 949-364-2778
Mailing address:
  • Phone: 949-364-2440
  • Fax: 949-364-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG66486
License Number StateCA

VIII. Authorized Official

Name: JAMES A HEINRICH
Title or Position: OWNER
Credential: M.D.
Phone: 949-364-2440