Provider Demographics
NPI:1467548131
Name:HEITKAMP, JENNIFER MORGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MORGEN
Last Name:HEITKAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25435 VIA ADORNA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2909
Mailing Address - Country:US
Mailing Address - Phone:661-284-3780
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2523
Practice Address - Country:US
Practice Address - Phone:661-222-2800
Practice Address - Fax:661-255-3428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0526682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry