Healthcare Provider Details

I. General information

NPI: 1487748422
Provider Name (Legal Business Name): HEGWOOD MEDICAL GROUP PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 EL DORADO ST SUITE A1
MONTEREY CA
93940-4647
US

IV. Provider business mailing address

880 CASS ST SUITE 208
MONTEREY CA
93940-2947
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-6201
  • Fax: 831-649-3158
Mailing address:
  • Phone: 831-649-9000
  • Fax: 831-649-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TEKI SUSAN HEGWOOD
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 831-649-6201