1457461436 NPI number — DR. RONALD DAVID HARRIS RONALD HARRIS, M.D.

Table of content: DR. RONALD DAVID HARRIS RONALD HARRIS, M.D. (NPI 1457461436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457461436 NPI number — DR. RONALD DAVID HARRIS RONALD HARRIS, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
RONALD
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RONALD HARRIS, M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRIS
Provider Other First Name:
RONALD
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RONALD HARRIS, M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457461436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 GENTER ST
Provider Second Line Business Mailing Address:
# 102
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-5542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-459-9564
Provider Business Mailing Address Fax Number:
858-459-9561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 GENTER ST
Provider Second Line Business Practice Location Address:
# 102
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-459-9564
Provider Business Practice Location Address Fax Number:
858-459-9561
Provider Enumeration Date:
08/30/2006

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: 174400000X , with the licence number:  G20171 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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