Healthcare Provider Details

I. General information

NPI: 1508927005
Provider Name (Legal Business Name): JOHN GORDON HAROLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD STREET SUITE 750W
LOS ANGELES CA
90048-6108
US

IV. Provider business mailing address

8635 W 3RD STREET SUITE 750W
LOS ANGELES CA
90048-6018
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-2030
  • Fax: 310-659-1369
Mailing address:
  • Phone: 310-659-2030
  • Fax: 310-659-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG046536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: