Provider Demographics
NPI:1013654995
Name:HEINBACH, MICHAEL PRESTON (AGACNP-BC, ACCNS-AG)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PRESTON
Last Name:HEINBACH
Suffix:
Gender:M
Credentials:AGACNP-BC, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE # 7LONG
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-353-1387
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE # 7LONG
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-353-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017584207T00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery