Active NPI
Mary Lisa Hecker, OTR
- Rehabilitation Practitioner
- San Diego, CA
National Provider Identifier
1659495406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 0530012
- Practice address
- 1110 Carolina Lane
RM. 206
San Diego, CA 92102-3626 - Phone
- (619) 262-7342
- Fax
- (619) 262-8918
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 0530012 | CA | Primary |
Addresses
Primary practice location
1110 Carolina Lane
RM. 206
San Diego, CA 92102-3626
Mailing address
2074 Valley View Blvd
El Cajon, CA 92019-2059
Phone (619) 262-7342
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0530012 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659495406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2074 VALLEY VIEW BLVD",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920192059",
"telephone_number": "619-262-7342",
"fax_number": "619-262-8918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 CAROLINA LANE",
"address_2": "RM. 206",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921023626",
"telephone_number": "619-262-7342",
"fax_number": "619-262-8918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HECKER",
"first_name": "MARY",
"middle_name": "LISA",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "0530012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.