Healthcare Provider Details

I. General information

NPI: 1760546675
Provider Name (Legal Business Name): HARRIS L. GREENWALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MC BEAN PARKWAY B-2
VALENCIA CA
91355
US

IV. Provider business mailing address

23861 MC BEAN PARKWAY B-2
VALENCIA CA
91355
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-3232
  • Fax: 661-254-4212
Mailing address:
  • Phone: 661-254-3232
  • Fax: 661-254-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG-20771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: