Provider Demographics
NPI:1902672801
Name:HEINZ, GARRETT D
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:D
Last Name:HEINZ
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 1:14950 BRECKINRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GARRISON
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5098
Mailing Address - Country:US
Mailing Address - Phone:916-400-9966
Mailing Address - Fax:
Practice Address - Street 1:720 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4208
Practice Address - Country:US
Practice Address - Phone:831-424-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10970208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation