MEDICARE: DR. SARA E HEINEMANN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		CA
2	103T00000X	Psychologist	006003	AZ

General Provider Information

NPI Number	:	1235698689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA E HEINEMANN PSYD

Provider Business Mailing Address
First Line	:	1730 ROGERS PL APT 34
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-3699
Country	:	US
Telephone Number	:	760-288-1165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 ROGERS PL APT 34
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-3699
Country	:	US
Telephone Number	:	760-288-1165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	12/18/2025

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