=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760546675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRIS L. GREENWALD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23861 MC BEAN PARKWAY B-2
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-254-3232
-----------------------------------------------------
Fax | 661-254-4212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23861 MC BEAN PARKWAY B-2
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-254-3232
-----------------------------------------------------
Fax | 661-254-4212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G-20771
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------