Provider Demographics
NPI:1710947692
Name:HEINER, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:HEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WHITE RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-4843
Mailing Address - Country:US
Mailing Address - Phone:831-320-1082
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:NATIVIDAD MEDICAL CENTER, BLDG 300
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-751-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51617207V00000X, 207V00000X
CO42084207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35336285Medicaid
COI29364Medicare UPIN
CAI29364Medicare UPIN