Provider Demographics
NPI:1629237318
Name:HELLIESEN, JOHN STEVEN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:HELLIESEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12633 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2927
Mailing Address - Country:US
Mailing Address - Phone:562-945-5556
Mailing Address - Fax:562-945-8577
Practice Address - Street 1:12633 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2927
Practice Address - Country:US
Practice Address - Phone:562-945-5556
Practice Address - Fax:562-945-8577
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82429ZMedicaid
CAZZZ82429ZMedicaid