Healthcare Provider Details

I. General information

NPI: 1942443205
Provider Name (Legal Business Name): HARVEY HEINRICHS, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE SUITE 710
NEWPORT BEACH CA
92660-7708
US

IV. Provider business mailing address

P.O. BOX 8799
NEWPORT BEACH CA
92658-8799
US

V. Phone/Fax

Practice location:
  • Phone: 949-640-8575
  • Fax: 949-718-0848
Mailing address:
  • Phone: 949-640-8575
  • Fax: 949-718-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG16900
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG16900
License Number StateCA

VIII. Authorized Official

Name: HARVEY LLOYD HEINRICHS
Title or Position: OWNER
Credential: M.D.
Phone: 949-640-8576