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General NPI Number Information
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NPI Number | 1174969463
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Entity Type | Individual
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Provider Name | JASON HEINZEROTH C.P.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 1011 CASS ST SUITE 112
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City | MONTEREY
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State | CA
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Zip | 93940-4518
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Country | US
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Telephone | 831-375-2300
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Fax | 831-378-5240
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Provider Business Mailing Address
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Address Line | 1011 CASS ST SUITE 112
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City | MONTEREY
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State | CA
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Zip | 93940-4518
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Country | US
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Telephone | 408-500-8305
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Fax | 831-375-2400
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CP003844
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License Number State | DE
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