Provider Demographics
NPI:1265495014
Name:SOUMEKH, M HERTZEL (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:HERTZEL
Last Name:SOUMEKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8008 FROST ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4205
Mailing Address - Country:US
Mailing Address - Phone:858-560-8544
Mailing Address - Fax:858-560-8546
Practice Address - Street 1:8008 FROST ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4205
Practice Address - Country:US
Practice Address - Phone:858-560-8544
Practice Address - Fax:858-560-8546
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA37843207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A378430Medicaid
CAE02516Medicare UPIN
CA00A378430Medicaid