Provider Demographics
NPI:1093206757
Name:HERTZ, SARAH K
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:HERTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 SW MAD HATTER LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8509
Mailing Address - Country:US
Mailing Address - Phone:808-599-0941
Mailing Address - Fax:
Practice Address - Street 1:6275 SW MAD HATTER LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8509
Practice Address - Country:US
Practice Address - Phone:808-599-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2478175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist