Provider Demographics
NPI:1710001730
Name:HURWITZ, VANESSA KLESERT (PHD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KLESERT
Last Name:HURWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572093
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2093
Mailing Address - Country:US
Mailing Address - Phone:818-348-1996
Mailing Address - Fax:
Practice Address - Street 1:4201 LONG BEACH BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2007
Practice Address - Country:US
Practice Address - Phone:800-624-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner