Provider Demographics
NPI:1639301666
Name:HEINEBERG, YOTAM (DOCTORAL CANDIDATE)
Entity Type:Individual
Prefix:
First Name:YOTAM
Middle Name:
Last Name:HEINEBERG
Suffix:
Gender:M
Credentials:DOCTORAL CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 WAVERLY DR
Mailing Address - Street 2:315
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2052
Mailing Address - Country:US
Mailing Address - Phone:650-305-1176
Mailing Address - Fax:
Practice Address - Street 1:2471 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3394
Practice Address - Country:US
Practice Address - Phone:626-793-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner