Provider Demographics
NPI:1134909252
Name:HEINRITZ, CLARA JO (LAC)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:JO
Last Name:HEINRITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:J
Other - Last Name:HEINRITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:P.O. BOX 1582
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:805-801-4490
Mailing Address - Fax:
Practice Address - Street 1:699 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-1804
Practice Address - Fax:805-434-1855
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist