Healthcare Provider Details

I. General information

NPI: 1164590501
Provider Name (Legal Business Name): JONATHAN HARRIS HECHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR BLVD SUITE 306
PLEASANT HILL CA
94523-2147
US

IV. Provider business mailing address

400 TAYLOR BLVD SUITE 306
PLEASANT HILL CA
94523-2147
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-9688
  • Fax: 925-691-5091
Mailing address:
  • Phone: 925-691-9688
  • Fax: 925-691-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72698
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA72698
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101248173
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD038986
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: