Healthcare Provider Details

I. General information

NPI: 1265920730
Provider Name (Legal Business Name): CHRISTINA LAVENDER HARVIEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 250
PHOENIX AZ
85006-2722
US

IV. Provider business mailing address

5310 HARVEST HILL RD STE 290
DALLAS TX
75230-5826
US

V. Phone/Fax

Practice location:
  • Phone: 602-483-6504
  • Fax:
Mailing address:
  • Phone: 214-420-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number66220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: