Healthcare Provider Details

I. General information

NPI: 1932585361
Provider Name (Legal Business Name): KEVIN EUGENE HEARN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 WARING RD
OCEANSIDE CA
92056-4405
US

IV. Provider business mailing address

3905 WARING RD
OCEANSIDE CA
92056-4405
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-9000
  • Fax: 760-724-3686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA52488
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: