MEDICARE: MR. HAROLD WAITE

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	106H00000X	Marriage & Family Therapist	MFC42008	CA

General Provider Information

NPI Number	:	1407011836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD WAITE

Provider Business Mailing Address
First Line	:	1626 WILCOX AVE
Second Line	:	#170
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6234
Country	:	US
Telephone Number	:	323-855-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	7339 PYRAMID PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1312
Country	:	US
Telephone Number	:	323-855-0570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “ MR. HAROLD WAITE ” Practice Location

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