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General NPI Number Information
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NPI Number | 1194056234
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Entity Type | Organization
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Legal Business Name | TRACIE D HARVEY MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 4067 HARDWICK ST SUITE 313
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City | LAKEWOOD
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State | CA
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Zip | 90712-2350
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Country | US
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Telephone | 323-233-0425
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Fax | 323-432-5177
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Provider Business Mailing Address
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Address Line | 4067 HARDWICK ST SUITE 313
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City | LAKEWOOD
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State | CA
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Zip | 90712-2350
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Country | US
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Telephone | 323-233-0425
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Fax | 323-432-5177
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Authorized Official
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Title or Position | BILLER
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Name | EILEEN J VRIEZE
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Credential |
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Telephone | 909-946-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G83052
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License Number State | CA
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