Provider Demographics
NPI:1780452755
Name:HERTZ, HALEY D (MA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:D
Last Name:HERTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 DELTA FAIR BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4074
Mailing Address - Country:US
Mailing Address - Phone:925-301-0143
Mailing Address - Fax:
Practice Address - Street 1:3700 DELTA FAIR BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4074
Practice Address - Country:US
Practice Address - Phone:925-301-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program