Provider Demographics
NPI:1780979120
Name:HEINRICI, ALEKA DELAFIELD (MD)
Entity type:Individual
Prefix:
First Name:ALEKA
Middle Name:DELAFIELD
Last Name:HEINRICI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEKA
Other - Middle Name:DELAFIELD
Other - Last Name:SPURGEON HEINRICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:511 E SAN YSIDRO BLVD
Mailing Address - Street 2:1303
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3150
Mailing Address - Country:US
Mailing Address - Phone:503-933-9629
Mailing Address - Fax:
Practice Address - Street 1:4004 BEYER BLVD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2007
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine