Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 2624 | CA |
NPI | 1427624790 |
---|---|
Provider Name | Rodney Alexander Harris |
First Address | Culver City, CA 90232-6824 |
Second Address | Culver City, CA 90232-6824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2021 |
Last Update Date | 24/08/2021 |