Provider Demographics
NPI:1528268158
Name:HEINZ, THOMAS RANDAL (M D)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDAL
Last Name:HEINZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19111 CROYDEN TER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3504
Mailing Address - Country:US
Mailing Address - Phone:949-854-3397
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32045207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology