Basic Information
| Provider Information | |||||||||
| NPI: | 1780979120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINRICI | ||||||||
| FirstName: | ALEKA | ||||||||
| MiddleName: | DELAFIELD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPURGEON HEINRICI | ||||||||
| OtherFirstName: | ALEKA | ||||||||
| OtherMiddleName: | DELAFIELD | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 511 E SAN YSIDRO BLVD | ||||||||
| Address2: | 1303 | ||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921733150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039339629 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4004 BEYER BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921732007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196624100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A125329 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.