Provider Demographics
NPI:1871892331
Name:HEIKENS, MARC JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JEFFREY
Last Name:HEIKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8996 MIRAMAR RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4463
Mailing Address - Country:US
Mailing Address - Phone:619-949-3479
Mailing Address - Fax:619-625-3958
Practice Address - Street 1:8996 MIRAMAR RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4463
Practice Address - Country:US
Practice Address - Phone:619-949-3479
Practice Address - Fax:619-625-3958
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138136208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics