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General NPI Number Information
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NPI Number | 1114099918
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Entity Type | Individual
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Provider Name | MAYA HEINERT MD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4001 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3626
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Country | US
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Telephone | 330-493-4443
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Fax | 330-493-8677
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Provider Business Mailing Address
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Address Line | 4535 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718-2545
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Country | US
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Telephone | 330-493-4443
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Fax | 330-493-8677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G85979
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License Number State | CA
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