Provider Demographics
NPI:1851476113
Name:HIRSH, LINDA JOYCE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JOYCE
Last Name:HIRSH
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 1:2901 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2919
Mailing Address - Country:US
Mailing Address - Phone:310-413-9643
Mailing Address - Fax:310-396-6736
Practice Address - Street 1:2901 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2919
Practice Address - Country:US
Practice Address - Phone:310-413-9643
Practice Address - Fax:310-396-6736
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03069FMedicaid
CADME03069FMedicaid