Healthcare Provider Details

I. General information

NPI: 1376337055
Provider Name (Legal Business Name): TEZA HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLAZA, (EMERGENCY MEDICINE)
LOS ANGELES CA
90095
US

IV. Provider business mailing address

757 WESTWOOD PLAZA, (EMERGENCY MEDICINE)
LOS ANGELES CA
90095
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-0785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: