Healthcare Provider Details

I. General information

NPI: 1073729539
Provider Name (Legal Business Name): HARLEEN HAYREH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE 1ST FLOOR- PULMONARY DEPARTMENT
LOS ANGELES CA
90027-5337
US

IV. Provider business mailing address

1515 N VERMONT AVE 1ST FLOOR- PULMONARY DEPARTMENT
LOS ANGELES CA
90027-5337
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4858
  • Fax:
Mailing address:
  • Phone: 323-783-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA104937
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA104937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: