Provider Demographics
NPI:1740580646
Name:HEHR, JAKE TIMOTHY
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:TIMOTHY
Last Name:HEHR
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 1:10016 SCRIPPS RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1222
Mailing Address - Country:US
Mailing Address - Phone:858-621-5120
Mailing Address - Fax:
Practice Address - Street 1:10016 SCRIPPS RANCH BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1222
Practice Address - Country:US
Practice Address - Phone:858-621-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist