Provider Demographics
NPI:1558979179
Name:HIRSCH, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1607
Mailing Address - Country:US
Mailing Address - Phone:510-866-5812
Mailing Address - Fax:
Practice Address - Street 1:1196 KEITH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1607
Practice Address - Country:US
Practice Address - Phone:510-866-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist