Basic Information
| Provider Information | |||||||||
| NPI: | 1639301666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINEBERG | ||||||||
| FirstName: | YOTAM | ||||||||
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| Credential: | DOCTORAL CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 WAVERLY DR | ||||||||
| Address2: | 315 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900392052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503051176 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2471 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267935141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2009 | ||||||||
| LastUpdateDate: | 08/08/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.