Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G45267 | CA |
NPI | 1104904051 |
---|---|
Provider Name | Richard M Harris |
First Address | Burbank, CA 91510-0609 |
Second Address | Los Angeles, CA 90035-1148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 10/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92566 | (02) |