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General NPI Number Information
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NPI Number | 1073729497
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Entity Type | Organization
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Legal Business Name | IVOR H. HAREWOOD, M.D, FACS AMC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3701 STOCKER ST SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90008-5108
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Country | US
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Telephone | 323-296-6942
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Fax | 323-299-1651
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Provider Business Mailing Address
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Address Line | PO BOX 8387
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City | LOS ANGELES
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State | CA
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Zip | 90008-0387
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Country | US
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Telephone | 323-296-6942
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Fax | 323-299-1651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVOR H. HAREWOOD
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Credential | M.D.
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Telephone | 323-296-6942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G23311
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License Number State | CA
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