Provider Demographics
NPI:1922105618
Name:HIRT, DAVID M (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:HIRT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11999 SAN VICENTE BLVD
Mailing Address - Street 2:#440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5131
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-471-3958
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:#130
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:310-471-5852
Practice Address - Fax:310-471-3958
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC36627207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083780Medicaid
CAGR0083781Medicaid
CAZZZ40551ZMedicaid
CAZZZ40551ZMedicaid
CAWC36627CMedicare PIN
CAGR0083780Medicaid
CAWC36627BMedicare PIN
CAW296BMedicare PIN