Provider Demographics
NPI:1962408427
Name:REAVES, HAROLD E (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:E
Last Name:REAVES
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 1:420 E 3RD ST
Mailing Address - Street 2:STE 603
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-680-1551
Mailing Address - Fax:213-680-2148
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:STE 603
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1645
Practice Address - Country:US
Practice Address - Phone:213-680-1551
Practice Address - Fax:213-680-2148
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G338350Medicaid
CA00G338350Medicaid
CABP073ZMedicare PIN
CA0523690001Medicare NSC