Provider Demographics
NPI:1629144985
Name:MORRISON, ANDREA HERZBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HERZBERG
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:HERZBERG
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18399 VENTURA BLVD
Mailing Address - Street 2:#239
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-881-0412
Mailing Address - Fax:818-881-3667
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:#239
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-881-0412
Practice Address - Fax:818-881-3667
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN6328620OtherDEA LICENSE
CAAN6328620OtherDEA LICENSE