Great Harbor Family & Sports Medicine, Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20A7368 Issued in CA

Legal business name

GREAT HARBOR FAMILY & SPORTS MEDICINE, INC

Practice address

1294 W 6TH St
Suite 200
San Pedro, CA 90731-2987

Phone

(310) 521-1311

Fax

(310) 514-1313

NPI assigned

Apr 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elissa Schlichter, D.O.

Title

Medical Director

Phone

(310) 521-1311

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962629162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 W 6TH ST",
            "address_2": "SUITE 200",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312987",
            "telephone_number": "310-521-1311",
            "fax_number": "310-514-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 W 6TH ST",
            "address_2": "SUITE 200",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312987",
            "telephone_number": "310-521-1311",
            "fax_number": "310-514-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT HARBOR FAMILY & SPORTS MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHLICHTER",
        "authorized_official_first_name": "ELISSA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "310-521-1311",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A7368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Grace
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• Maricela H Gray
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• Michael Douglas Green, P.A.
• Lawrence Bruce Greenberg, M.D.
• Katelyn Greenspan, MA, LMFT
• Gregory Owens Licensed Marriage and Therapy Inc

• General Practice Physician in San Pedro, CA
• Providers in San Pedro, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.