1164612008 NPI number — F L HARCOURT M.D. INC

Table of content: (NPI 1164612008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164612008 NPI number — F L HARCOURT M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
F L HARCOURT M.D. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164612008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13952 EASTRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90602-1931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-945-2301
Provider Business Mailing Address Fax Number:
562-693-9221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7921 PAINTER AVE
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90602-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-945-2301
Provider Business Practice Location Address Fax Number:
562-945-9221
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARCOURT
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-945-2301

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  C14033 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00C140330 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00C140330 . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1548274525 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com