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Individual

DR. AVI J HETTENA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6037 LA GRANADA, SUITE C, RANCHO SANTA FE, CA 92067
(858) 756-2116
(858) 400-5113
Mailing address
PO BOX 7281, RANCHO SANTA FE, CA 92067-7281
(518) 637-8637
(415) 358-4754

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G45263
CA
207RN0300X
Nephrology Physician
Primary
G45263
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G452630
CA
01
110017611
MEDICARE RAILROAD
CA
Enumeration date
08/31/2006
Last updated
01/11/2017
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