Healthcare Provider Details

I. General information

NPI: 1831739614
Provider Name (Legal Business Name): HARBOR COMMUNITY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S PACIFIC AVE
SAN PEDRO CA
90731-2625
US

IV. Provider business mailing address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0202
  • Fax: 310-547-0202
Mailing address:
  • Phone: 310-547-0202
  • Fax: 310-547-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMRA KING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 310-547-8241