Organization
HERITAGE INTERNAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOL JIMENEZ GAZZINGAN M.D. (MANAGER)
(919) 435-0380
Entity
Organization
Contact information
Practice address
2824 ROGERS RD, SUITE 100, WAKE FOREST, NC 27587-3895
(919) 435-0380
Mailing address
305 HIDDEN LAKE DR, YOUNGSVILLE, NC 27596-7471
(919) 435-0380
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
200701946
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912424
—
NC
Enumeration date
11/16/2011
Last updated
11/16/2011
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