Healthcare Provider Details

I. General information

NPI: 1629936661
Provider Name (Legal Business Name): HARBOR COMMUNITY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE STE 101
LONG BEACH CA
90813-3265
US

IV. Provider business mailing address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0202
  • Fax:
Mailing address:
  • Phone: 310-547-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAHINA CLARIZZA HERNANDEZ
Title or Position: CREDENTIALING & COMPLIANCE ANALYST
Credential:
Phone: 310-547-0202