Individual ProviderEllen K HeynemanPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223(858) 966-4935PECOS EnrollmentBased on the most recent information from CMS, provider Ellen K Heyneman does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1598797847Provider TypeIndividualFull NameHeyneman, Ellen KTitleDr.CredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date7/7/2006Last Updated10/15/2015Contact InformationPractice LocationPractice Address3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223Phone(858) 966-4935Fax(858) 966-7525Mailing LocationMailing Address3020 Childrens Way, Mail Code 5018, San Diego, CA 92123-4223Phone(858) 966-4935Fax(858) 966-7525Provider TaxonomiesCodeDescriptionLicenseCode2084P0804XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseG68996CaliforniaCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseG68996CaliforniaCode2084P0800XDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseG68996CaliforniaProvider IdentifiersIDDescriptionIssuerID00G689960DescriptionMedicaidIssuerUnlistedCalifornia