Provider Demographics
NPI:1063527406
Name:HARTZLER, JANET K (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:K
Last Name:HARTZLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72057 DINAH SHORE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1791
Mailing Address - Country:US
Mailing Address - Phone:760-340-3937
Mailing Address - Fax:760-340-1940
Practice Address - Street 1:72057 DINAH SHORE DR
Practice Address - Street 2:SUITE D
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1791
Practice Address - Country:US
Practice Address - Phone:760-340-3937
Practice Address - Fax:760-340-1940
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G404552Medicare UPIN
00G404553Medicare UPIN
00G404550Medicare PIN
00G404551Medicare PIN
D24105Medicare UPIN