Basic Information
Provider Information
NPI: 1740305630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARNED
FirstName: THERESA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1333 S MAYFLOWER AVE FL 2
Address2:  
City: MONROVIA
State: CA
PostalCode: 910164066
CountryCode: US
TelephoneNumber: 6267753514
FaxNumber: 6264083911
Practice Location
Address1: 1500 DUARTE RD
Address2:  
City: DUARTE
State: CA
PostalCode: 910103012
CountryCode: US
TelephoneNumber: 6263598111
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/20/2007
LastUpdateDate: 11/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XA83397CAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


Home