Healthcare Provider Details

I. General information

NPI: 1245566512
Provider Name (Legal Business Name): JANEY M HEYTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

830 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7700
  • Fax: 209-558-7286
Mailing address:
  • Phone: 209-558-7700
  • Fax: 209-558-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: