Provider Demographics
NPI:1144391970
Name:HEINSHEIMER, JOAN GABRIELLA (MD)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:GABRIELLA
Last Name:HEINSHEIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6159 BERNHARD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1230
Mailing Address - Country:US
Mailing Address - Phone:510-220-6668
Mailing Address - Fax:510-778-9061
Practice Address - Street 1:400 EVELYN AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1372
Practice Address - Country:US
Practice Address - Phone:510-220-6668
Practice Address - Fax:510-778-9061
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG037147208D00000X
PAG037147208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G371470Medicare ID - Type Unspecified
PA00G371470Medicare ID - Type Unspecified
A46975Medicare UPIN