MEDICARE: IVOR H. HAREWOOD, M.D, FACS AMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	G23311	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073729497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVOR H. HAREWOOD, M.D, FACS AMC

Provider Business Mailing Address
First Line	:	PO BOX 8387
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-0387
Country	:	US
Telephone Number	:	323-296-6942
Fax Number	:	323-299-1651

Provider Business Practice Location Address
First Line	:	3701 STOCKER ST
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5108
Country	:	US
Telephone Number	:	323-296-6942
Fax Number	:	323-299-1651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IVOR H. HAREWOOD
Credential	:	M.D.
Telephone Number	:	323-296-6942

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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