Healthcare Provider Details

I. General information

NPI: 1710001730
Provider Name (Legal Business Name): VANESSA KLESERT HURWITZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LONG BEACH BLVD SUITE 406
LONG BEACH CA
90807-2007
US

IV. Provider business mailing address

PO BOX 572093
TARZANA CA
91357-2093
US

V. Phone/Fax

Practice location:
  • Phone: 800-624-1475
  • Fax:
Mailing address:
  • Phone: 818-348-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: