Healthcare Provider Details

I. General information

NPI: 1487576625
Provider Name (Legal Business Name): HARBINDER S DHARIWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14003 HIGHLANDER RD
LA MIRADA CA
90638-6601
US

IV. Provider business mailing address

14003 HIGHLANDER RD
LA MIRADA CA
90638-6601
US

V. Phone/Fax

Practice location:
  • Phone: 714-330-5848
  • Fax:
Mailing address:
  • Phone: 714-330-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number060004396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: