# GREAT HARBOR FAMILY & SPORTS MEDICINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962629162
- **Authorized official:** ELISSA SCHLICHTER D.O. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 521-1311

## Contact information

- **Practice address:** 1294 W 6TH ST, SUITE 200, SAN PEDRO, CA 90731-2987
- **Practice address phone:** (310) 521-1311
- **Practice address fax:** (310) 514-1313
- **Mailing address:** 1294 W 6TH ST, SUITE 200, SAN PEDRO, CA 90731-2987
- **Mailing address phone:** (310) 521-1311
- **Mailing address fax:** (310) 514-1313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 20A7368 | CA | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 08/22/2020