Provider Demographics
NPI:1588040794
Name:TARRAB HERZLICH, AVIV (MD)
Entity Type:Individual
Prefix:DR
First Name:AVIV
Middle Name:
Last Name:TARRAB HERZLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E EL SEGUNDO BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2743
Mailing Address - Country:US
Mailing Address - Phone:310-784-8745
Mailing Address - Fax:
Practice Address - Street 1:2110 E EL SEGUNDO BLVD STE 220
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2743
Practice Address - Country:US
Practice Address - Phone:310-784-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300462207V00000X
CAA171982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology