Provider Demographics
NPI:1245402130
Name:HIRSH, HEATHER (PA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:HIRSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MACAW LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3152
Mailing Address - Country:US
Mailing Address - Phone:805-584-1930
Mailing Address - Fax:805-584-1932
Practice Address - Street 1:158 MACAW LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3152
Practice Address - Country:US
Practice Address - Phone:805-584-1930
Practice Address - Fax:805-584-1932
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant