Healthcare Provider Details

I. General information

NPI: 1992744379
Provider Name (Legal Business Name): TERESITA S. HARMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CIVIC CENTER LN
LAKE HAVASU CITY AZ
86403-5607
US

IV. Provider business mailing address

PO BOX 51346
LOS ANGELES CA
90051-5646
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-8185
  • Fax:
Mailing address:
  • Phone: 702-304-2144
  • Fax: 702-304-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9095
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC210549
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9095
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: