Provider Demographics
NPI:1942690300
Name:HELWIG, RANDY (RD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HELWIG
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 PONDEROSA WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95246-9469
Mailing Address - Country:US
Mailing Address - Phone:209-754-2666
Mailing Address - Fax:
Practice Address - Street 1:768 MOUNTAIN RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9707
Practice Address - Country:US
Practice Address - Phone:209-754-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA955336282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural