Provider Demographics
NPI:1215136957
Name:HARWICK, DONALD T (PA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:HARWICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 N LOOP BLVD
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-2269
Mailing Address - Country:US
Mailing Address - Phone:760-373-1256
Mailing Address - Fax:760-373-1214
Practice Address - Street 1:9300 N LOOP BLVD
Practice Address - Street 2:SUITE A&B
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2269
Practice Address - Country:US
Practice Address - Phone:760-373-1256
Practice Address - Fax:760-373-1214
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13177OtherPA LICENSE