Provider Demographics
NPI:1760431027
Name:HERTZ, DANICE (MD)
Entity Type:Individual
Prefix:
First Name:DANICE
Middle Name:
Last Name:HERTZ
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 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 360W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-1871
Mailing Address - Fax:310-453-3910
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 360W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-1871
Practice Address - Fax:310-453-3910
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52302207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93146Medicare UPIN
G52302Medicare ID - Type Unspecified