Healthcare Provider Details

I. General information

NPI: 1164416517
Provider Name (Legal Business Name): HARRY DRUMMOND III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 ALAMO ST SUITE 100
SIMI VALLEY CA
93065-1311
US

IV. Provider business mailing address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-5810
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-7280
  • Fax: 805-210-4716
Mailing address:
  • Phone: 805-987-7063
  • Fax: 805-322-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG29685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number79889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: