NPIMap

Organization Active NPI

Heritage Orthopedic and Industrial Medicine Multispecialty Medicine

  • Orthopedic Chiropractor
  • Reseda, CA
National Provider Identifier
1194970087
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
G62809 Issued in CA
Legal business name
HERITAGE ORTHOPEDIC AND INDUSTRIAL MEDICINE MULTISPECIALTY MEDICINE
Practice address
17750 Sherman Way
Ste: 100
Reseda, CA 91335-3380
Phone
(818) 705-7200
Fax
(818) 342-8567
NPI assigned
Nov 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Allen Fonseca, MD
Title
Medical Director
Phone
(818) 705-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X G62809 CA Primary

Addresses

Primary practice location

17750 Sherman Way
Ste: 100
Reseda, CA 91335-3380

Mailing address

17750 Sherman Way
Ste: 100
Reseda, CA 91335-3380
Phone (818) 705-7200

National Provider Directory

National Provider Directory
Tax ID family
Heritage Orthopedic Industrial Medicine Multi-Specialty Group Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1194970087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17750 SHERMAN WAY",
            "address_2": "STE: 100",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353380",
            "telephone_number": "818-705-7200",
            "fax_number": "818-342-8567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17750 SHERMAN WAY",
            "address_2": "STE: 100",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353380",
            "telephone_number": "818-705-7200",
            "fax_number": "818-342-8567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE ORTHOPEDIC AND INDUSTRIAL MEDICINE MULTISPECIALTY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "FONSECA",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-705-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "CA",
            "license": "G62809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.