MEDICARE: DR. HIAWATHA HARRIS M.D.

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	2084P0800X	Psychiatry Physician	C22371	CA

General Provider Information

NPI Number	:	1780722488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIAWATHA HARRIS M.D.

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1415
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4005
Country	:	US
Telephone Number	:	213-481-0355
Fax Number	:	213-250-3092

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1415
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4005
Country	:	US
Telephone Number	:	213-481-0355
Fax Number	:	213-250-3092

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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