1083758981 NPI number — FLORENCE BRAGANZA HARRIS M.D.

Table of content: FLORENCE BRAGANZA HARRIS M.D. (NPI 1083758981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083758981 NPI number — FLORENCE BRAGANZA HARRIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
FLORENCE
Provider Middle Name:
BRAGANZA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083758981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4505 S MARYLAND PKWY, BOX 453020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89154-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-895-3370
Provider Business Mailing Address Fax Number:
702-895-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 S MARYLAND PKWY
Provider Second Line Business Practice Location Address:
BOX 453020
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89154-9900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-895-3370
Provider Business Practice Location Address Fax Number:
702-895-4316
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  7875 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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