=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982749339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HILARY BACHMAN KERSHBERG M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 MCCONNELL AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90066-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-462-9013
-----------------------------------------------------
Fax | 949-215-5160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 PALLAZO CIR
-----------------------------------------------------
City | FOOTHILL RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92610-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-462-9013
-----------------------------------------------------
Fax | 949-215-5160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 870017
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------