Healthcare Provider Details

I. General information

NPI: 1225556673
Provider Name (Legal Business Name): JEFF HARRIS, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23805 STUART RANCH RD. #310
MALIBU CA
90265
US

IV. Provider business mailing address

23805 STUART RANCH RD # 210
MALIBU CA
90265-4856
US

V. Phone/Fax

Practice location:
  • Phone: 714-389-7420
  • Fax: 310-456-9772
Mailing address:
  • Phone: 714-389-7420
  • Fax: 310-456-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA24797
License Number StateCA

VIII. Authorized Official

Name: COLETTE THILKEN
Title or Position: OFFICE ADMINSITRATOR
Credential:
Phone: 949-533-0319