Organization
HERITAGE ORTHOPEDIC & INDUSTRIAL MEDICINE MULTI-SPECIALTY MED GRP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN FONSECA MD (MEDICAL DIRECTOR)
(818) 716-9434
Entity
Organization
Contact information
Practice address
22030 SHERMAN WAY STE 101, CANOGA PARK, CA 91303-1844
(818) 716-9434
Mailing address
22030 SHERMAN WAY STE 101, CANOGA PARK, CA 91303-1844
(818) 716-9434
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
G62809
CA
Other
Enumeration date
02/19/2009
Last updated
02/19/2009
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