1588068191 NPI number — HARBOR NEUROLOGICAL GROUP

Table of content: (NPI 1588068191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588068191 NPI number — HARBOR NEUROLOGICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR NEUROLOGICAL GROUP
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:
1588068191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21039 FIGUEROA ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90745-1972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-705-0737
Provider Business Mailing Address Fax Number:
310-618-6989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13701 BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-705-0737
Provider Business Practice Location Address Fax Number:
310-388-5802
Provider Enumeration Date:
10/13/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUONG
Authorized Official First Name:
KHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
714-705-0737

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  A64097 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: A86632 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213EP1101X , with the licence number: E4237 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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