Healthcare Provider Details

I. General information

NPI: 1982502027
Provider Name (Legal Business Name): DESIREE HARBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2026
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BOLEY ST
MONROVIA CA
91016-4905
US

IV. Provider business mailing address

325 E HUNTINGTON DR
MONROVIA CA
91016-6419
US

V. Phone/Fax

Practice location:
  • Phone: 626-471-2400
  • Fax:
Mailing address:
  • Phone: 626-471-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberEF97D4D21C
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: