Healthcare Provider Details

I. General information

NPI: 1366650285
Provider Name (Legal Business Name): NANCY HARO IMF53146
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD 500
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

8162 MANITOBA ST UNIT 116
PLAYA DEL REY CA
90293-8642
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-1347
  • Fax:
Mailing address:
  • Phone: 323-804-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF53146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: