Provider Demographics
NPI:1326296880
Name:HARDING, PHILLIP REGINALD (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:REGINALD
Last Name:HARDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3700
Mailing Address - Country:US
Mailing Address - Phone:626-281-8663
Mailing Address - Fax:626-281-6318
Practice Address - Street 1:101 E BEVERLY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4314
Practice Address - Country:US
Practice Address - Phone:323-728-0655
Practice Address - Fax:323-728-7794
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24876207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248760Medicaid
CAA24876OtherMEDICAL LICENSE
CAA24876OtherMEDICAL LICENSE