Healthcare Provider Details

I. General information

NPI: 1205761442
Provider Name (Legal Business Name): ANDRE SIMON HARRIAGUE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 BIRCH ST STE 106
NEWPORT BEACH CA
92660-2228
US

IV. Provider business mailing address

30001 GOLDEN LANTERN APT 262
LAGUNA NIGUEL CA
92677-5833
US

V. Phone/Fax

Practice location:
  • Phone: 949-263-9003
  • Fax: 949-263-9002
Mailing address:
  • Phone: 949-697-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: