Provider Demographics
NPI:1669023321
Name:HARTZ, VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:HARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9398
Mailing Address - Country:US
Mailing Address - Phone:530-938-4072
Mailing Address - Fax:
Practice Address - Street 1:4624 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-9398
Practice Address - Country:US
Practice Address - Phone:530-938-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider