Healthcare Provider Details

I. General information

NPI: 1245516053
Provider Name (Legal Business Name): KYLE CHRISTAN HERZBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY
SPARKS NV
89431-5564
US

IV. Provider business mailing address

1672 LONDON CIR
SPARKS NV
89431-1913
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax: 775-324-1541
Mailing address:
  • Phone:
  • 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: