Organization
HERITAGE ORTHOPEDIC AND INDUSTRIAL MEDICINE MULTISPECIALTY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN FONSECA MD (MEDICAL DIRECTOR)
(818) 705-7200
Entity
Organization
Contact information
Practice address
17750 SHERMAN WAY, STE: 100, RESEDA, CA 91335-3380
(818) 705-7200
(818) 342-8567
Mailing address
17750 SHERMAN WAY, STE: 100, RESEDA, CA 91335-3380
(818) 705-7200
(818) 342-8567
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
G62809
CA
Other
Enumeration date
11/19/2008
Last updated
11/19/2008
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