Healthcare Provider Details

I. General information

NPI: 1992892822
Provider Name (Legal Business Name): AMY NEVIN HARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SAN MIGUEL DR STE 375
NEWPORT BEACH CA
92660-7847
US

IV. Provider business mailing address

369 SAN MIGUEL DR STE 375
NEWPORT BEACH CA
92660-7847
US

V. Phone/Fax

Practice location:
  • Phone: 949-220-0510
  • Fax: 949-220-0509
Mailing address:
  • Phone: 949-220-0510
  • Fax: 949-220-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA100728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: