Healthcare Provider Details

I. General information

NPI: 1982749339
Provider Name (Legal Business Name): HILARY BACHMAN KERSHBERG M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HILARY BETH BACHMAN

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

IV. Provider business mailing address

4 PALLAZO CIR
FOOTHILL RANCH CA
92610-1930
US

V. Phone/Fax

Practice location:
  • Phone: 949-462-9013
  • Fax: 949-215-5160
Mailing address:
  • Phone: 949-462-9013
  • Fax: 949-215-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number870017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: