Healthcare Provider Details

I. General information

NPI: 1366649089
Provider Name (Legal Business Name): TODD LEE HARSHBARGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 370
BURBANK CA
91505-4562
US

IV. Provider business mailing address

PO BOX 18111
ANAHEIM CA
92817-8111
US

V. Phone/Fax

Practice location:
  • Phone: 213-787-7834
  • Fax: 213-559-0929
Mailing address:
  • Phone: 213-787-7834
  • Fax: 213-559-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA66076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: