Provider Demographics
NPI:1396039301
Name:HEGYI, EDIT (MD, PHD)
Entity Type:Individual
Prefix:
First Name:EDIT
Middle Name:
Last Name:HEGYI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16769 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE K13
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2546
Mailing Address - Country:US
Mailing Address - Phone:760-522-1360
Mailing Address - Fax:
Practice Address - Street 1:16769 BERNARDO CENTER DR
Practice Address - Street 2:SUITE K13
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2546
Practice Address - Country:US
Practice Address - Phone:760-522-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89002261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center