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General NPI Number Information
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NPI Number | 1255542908
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Entity Type | Organization
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Legal Business Name | RICHARD HEIDENFELDER MD
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 447 9TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-7369
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Country | US
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Telephone | 619-435-4088
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Fax | 619-435-4088
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Provider Business Mailing Address
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Address Line | 826 ORANGE AVE # 605
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City | CORONADO
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State | CA
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Zip | 92118-2619
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Country | US
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Telephone | 619-435-4088
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Fax | 619-435-4088
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD PAUL HEIDENFELDER
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Credential | MD
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Telephone | 619-435-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A79836
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License Number State | CA
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