Individual
DR. JOHN A. HATHERLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1225 WILSHIRE BOULEVARD, LOS ANGELES, CA 90017-2395
(213) 977-2423
(213) 202-7028
Mailing address
2550 NORTH HOLLYWOOD WAY, SUITE 209, BURBANK, CA 91505-5019
(818) 557-0135
(818) 557-1394
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G52940
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G529400
CALOPTIMA
CA
05
—
00G529400
—
CA
01
—
G52940
BLUE CROSS
CA
Enumeration date
05/19/2006
Last updated
07/09/2007
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