Healthcare Provider Details

I. General information

NPI: 1831204882
Provider Name (Legal Business Name): ALAN MAX HELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE STE. 203
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

2039 FOREST AVE STE. 203
SAN JOSE CA
95128-4817
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-6030
  • Fax: 408-297-8612
Mailing address:
  • Phone: 408-297-6030
  • Fax: 408-297-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA32272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: