Provider Demographics
NPI:1720130784
Name:PEART, HAROLD T (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:T
Last Name:PEART
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 1:6091 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2648
Mailing Address - Country:US
Mailing Address - Phone:323-935-1178
Mailing Address - Fax:323-935-0577
Practice Address - Street 1:6091 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2648
Practice Address - Country:US
Practice Address - Phone:323-935-1178
Practice Address - Fax:323-935-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40523207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G405230Medicaid
CA00G405230Medicaid
CAA48254Medicare UPIN