Healthcare Provider Details

I. General information

NPI: 1982905402
Provider Name (Legal Business Name): MR. MICHAEL CARLETON HARLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S PASEO DOROTEA SUITE 2
PALM SPRINGS CA
92264-1437
US

IV. Provider business mailing address

31202 GARDENSIDE LN
MENIFEE CA
92584-8299
US

V. Phone/Fax

Practice location:
  • Phone: 760-851-4271
  • Fax:
Mailing address:
  • Phone: 760-851-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: