Healthcare Provider Details

I. General information

NPI: 1295939163
Provider Name (Legal Business Name): JUSTIN HEATH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E WILLIAMS AVE
FALLON NV
89406-3031
US

IV. Provider business mailing address

1155 MILL ST # M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-2988
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10567
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1587
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: