Provider Demographics
NPI:1598821316
Name:HIRSCH, LISA BETH (MD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
Last Name:HIRSCH
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 1:360 SAN MIGUEL
Mailing Address - Street 2:#308
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-720-0511
Mailing Address - Fax:949-720-9404
Practice Address - Street 1:360 SAN MIGUEL
Practice Address - Street 2:#308
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-720-0511
Practice Address - Fax:949-720-9404
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO44830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16808Medicare UPIN
CAWA44830DMedicare ID - Type Unspecified