Provider Demographics
NPI:1528695046
Name:HARDLEY, MACY TIANELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MACY
Middle Name:TIANELLE
Last Name:HARDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MACY
Other - Middle Name:TIANELLE
Other - Last Name:HARDLEY WASHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4900 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5814
Mailing Address - Country:US
Mailing Address - Phone:323-783-4603
Mailing Address - Fax:
Practice Address - Street 1:4900 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5814
Practice Address - Country:US
Practice Address - Phone:323-783-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA195479207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology