Provider Demographics
NPI:1952369407
Name:HAWORTH, LOREN IRA (MD)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:IRA
Last Name:HAWORTH
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 1:1479 W LACEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5906
Mailing Address - Country:US
Mailing Address - Phone:559-583-4617
Mailing Address - Fax:559-583-4625
Practice Address - Street 1:1455 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE COVE
Practice Address - State:CA
Practice Address - Zip Code:93646-9322
Practice Address - Country:US
Practice Address - Phone:559-626-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G7477450OtherMEDICAL
00G7477450OtherMEDICAL