Provider Demographics
NPI:1649395856
Name:HARLAN, RUSSELL L (HEARING INSTRUMENT S)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:L
Last Name:HARLAN
Suffix:
Gender:M
Credentials:HEARING INSTRUMENT S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4622
Mailing Address - Country:US
Mailing Address - Phone:714-535-7508
Mailing Address - Fax:714-535-4086
Practice Address - Street 1:697 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4622
Practice Address - Country:US
Practice Address - Phone:714-535-7508
Practice Address - Fax:714-535-4086
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2105237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist