Healthcare Provider Details

I. General information

NPI: 1225227713
Provider Name (Legal Business Name): D LEVI HARRISON MD A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 204
GLENDALE CA
91204-4379
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 204
GLENDALE CA
91204-4379
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-8001
  • Fax: 818-240-8019
Mailing address:
  • Phone: 818-240-8001
  • Fax: 818-240-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA73863
License Number StateCA

VIII. Authorized Official

Name: DR. DANNY LEVI HARRISON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-989-6260