Provider Demographics
NPI:1629045984
Name:HEITTER, DAVID ORVILLE (PAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ORVILLE
Last Name:HEITTER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 N CALIFORNIA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7249
Mailing Address - Country:US
Mailing Address - Phone:925-225-5837
Mailing Address - Fax:925-482-2834
Practice Address - Street 1:800 E. WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531
Practice Address - Country:US
Practice Address - Phone:707-464-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00751363A00000X
CAPA12674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA126743Medicare PIN
OR109734Medicare PIN
P34037Medicare UPIN