Healthcare Provider Details

I. General information

NPI: 1306159546
Provider Name (Legal Business Name): JOSHUA HEITZMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CURTNER AVE STE C
SAN JOSE CA
95124-1330
US

IV. Provider business mailing address

2100 CURTNER AVE STE C
SAN JOSE CA
95124-1330
US

V. Phone/Fax

Practice location:
  • Phone: 669-203-4847
  • Fax:
Mailing address:
  • Phone: 669-203-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY26746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: