Basic Information
| Provider Information | |||||||||
| NPI: | 1700923059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRSCH | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 15TH STREET | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703920900 | ||||||||
| FaxNumber: | 9705063785 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 15TH ST STE 310 | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806314562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703920900 | ||||||||
| FaxNumber: | 9705063795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43791 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 43791 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | DR-43791 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 85103268 | 05 | CO | MEDICAID |