Provider Demographics
NPI:1548639800
Name:HEINTZ, MATT JAY
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:JAY
Last Name:HEINTZ
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 1:1450 DOMINGUEZ RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7906
Mailing Address - Country:US
Mailing Address - Phone:909-319-2515
Mailing Address - Fax:951-736-9076
Practice Address - Street 1:1450 DOMINGUEZ RANCH RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7906
Practice Address - Country:US
Practice Address - Phone:909-319-2515
Practice Address - Fax:951-736-9076
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor