Provider Demographics
NPI:1619976784
Name:HARRIMAN, IRMA S (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:S
Last Name:HARRIMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-901-9906
Mailing Address - Fax:818-901-9849
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-901-9906
Practice Address - Fax:818-901-9849
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34846207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348461Medicaid
CAWA34846AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE