Provider Demographics
NPI:1720364524
Name:NAIR, HARILAL (NP)
Entity Type:Individual
Prefix:MR
First Name:HARILAL
Middle Name:
Last Name:NAIR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:HARILAL
Other - Middle Name:
Other - Last Name:KRISHNANKUTTYNAIR VASANTHAKUMARIAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7463 STAR PINE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5817
Mailing Address - Country:US
Mailing Address - Phone:909-907-1174
Mailing Address - Fax:909-907-1174
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:909-475-7064
Practice Address - Fax:909-881-7131
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20370363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health