Provider Demographics
NPI:1326416264
Name:HERTZBERG, RACHEL (LVN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HERTZBERG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ALISO AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5104
Mailing Address - Country:US
Mailing Address - Phone:949-285-2982
Mailing Address - Fax:
Practice Address - Street 1:2000 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3805
Practice Address - Country:US
Practice Address - Phone:949-285-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN287151164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse