Healthcare Provider Details

I. General information

NPI: 1588879175
Provider Name (Legal Business Name): DAVID HEANEY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W ACEQUIA AVE STE A
VISALIA CA
93291-6131
US

IV. Provider business mailing address

515 W ACEQUIA AVE STE A
VISALIA CA
93291-6131
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-9707
  • Fax: 559-733-7009
Mailing address:
  • Phone: 559-733-9707
  • Fax: 559-733-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number00A301420
License Number StateCA

VIII. Authorized Official

Name: SARAH HEANEY
Title or Position: BOD: SECRETARY, ADMINISTRATOR
Credential:
Phone: 559-733-9707