Healthcare Provider Details

I. General information

NPI: 1811713357
Provider Name (Legal Business Name): JUSTIN HARSHMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 AVIATION BLVD STE 100
HAWTHORNE CA
90250-6667
US

IV. Provider business mailing address

16906 NE 101ST PL
REDMOND WA
98052-3143
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-6731
  • Fax:
Mailing address:
  • Phone: 425-894-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: