Provider Demographics
NPI:1740388818
Name:IRIAFEN, HARRISON M
Entity Type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:M
Last Name:IRIAFEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14640 VICTORY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1623
Mailing Address - Country:US
Mailing Address - Phone:818-785-3584
Mailing Address - Fax:818-785-7910
Practice Address - Street 1:14640 VICTORY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1623
Practice Address - Country:US
Practice Address - Phone:818-785-3584
Practice Address - Fax:818-785-7910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45959332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5788430001Medicare NSC