Provider Demographics
NPI:1821701947
Name:HERTZBERG, LORRAINE SUE (ELECTROLOGIST RE)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:SUE
Last Name:HERTZBERG
Suffix:
Gender:F
Credentials:ELECTROLOGIST RE
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 22873
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192
Mailing Address - Country:US
Mailing Address - Phone:760-715-2826
Mailing Address - Fax:
Practice Address - Street 1:1011 CAMINO DEL MAR #210
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:760-715-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3466374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician