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NPI Code Detail

MEDICARE: DR. SCOTT KEITH HARRIS PSY.D

MEDICARE: DR. SCOTT KEITH HARRIS PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist22416CA

General Provider Information

NPI Number : 1467620138
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT KEITH HARRIS PSY.D
Provider Business Mailing Address
First Line : 1094 CUDAHY PL STE 314
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3924
Country : US
Telephone Number : 619-276-8112
Fax Number : 619-276-8230
Provider Business Practice Location Address
First Line : 1094 CUDAHY PL STE 314
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3924
Country : US
Telephone Number : 619-276-8112
Fax Number : 619-276-8230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2008
Last Update Date : 08/30/2023

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