Provider Demographics
NPI:1174969463
Name:HEINZEROTH, JASON (CP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:HEINZEROTH
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CASS ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4518
Mailing Address - Country:US
Mailing Address - Phone:408-500-8305
Mailing Address - Fax:831-375-2400
Practice Address - Street 1:1011 CASS ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4518
Practice Address - Country:US
Practice Address - Phone:831-375-2300
Practice Address - Fax:831-378-5240
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP003844224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist