Provider Demographics
NPI:1649858820
Name:HERTZBERG, DAVID WAYNE (REIKI MASTER & TCM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:HERTZBERG
Suffix:
Gender:M
Credentials:REIKI MASTER & TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9119
Mailing Address - Country:US
Mailing Address - Phone:480-290-6071
Mailing Address - Fax:
Practice Address - Street 1:3617 W EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9119
Practice Address - Country:US
Practice Address - Phone:480-290-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians