Provider Demographics
NPI:1609902261
Name:NEIL HERSH, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NEIL HERSH, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-301-5768
Mailing Address - Street 1:24882 ALICIA PARKWAY
Mailing Address - Street 2:SUITE E-333
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3446
Mailing Address - Country:US
Mailing Address - Phone:661-301-5768
Mailing Address - Fax:
Practice Address - Street 1:24896 CHRISANTA DR
Practice Address - Street 2:# 120
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4800
Practice Address - Country:US
Practice Address - Phone:661-301-5768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58484207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty