Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G13638 | CA |
N | 2080A0000X | Adolescent Medicine | G13638 | CA |
NPI | 1205867421 |
---|---|
Provider Name | Dr. Harvey Mitchell Harris |
First Address | Ventura, CA 93001-3712 |
Second Address | Ventura, CA 93001-3712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7069621 | (05) | CA |
A39047 | (02) | |
AH1452438 | DEA (01) |