Healthcare Provider Details

I. General information

NPI: 1659073351
Provider Name (Legal Business Name): KATHERINE JILL HEFCART MD, MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE JILL HEFLIN

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/24/2023
Certification Date: 12/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 QUARRY RD
PALO ALTO CA
94304-1419
US

IV. Provider business mailing address

401 QUARRY RD
PALO ALTO CA
94304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-5591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPTL13238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: