Provider Demographics
NPI:1497774954
Name:HIRSCH, RICK M (DO)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:M
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N EUCLID AVE
Mailing Address - Street 2:STE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8322
Mailing Address - Country:US
Mailing Address - Phone:909-920-9100
Mailing Address - Fax:909-920-9620
Practice Address - Street 1:300 N EUCLID AVE
Practice Address - Street 2:STE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8322
Practice Address - Country:US
Practice Address - Phone:909-920-9100
Practice Address - Fax:909-920-9620
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX72340Medicaid
CA00AX72340Medicaid
CAG87432Medicare UPIN
CA20A7234Medicare ID - Type Unspecified