Healthcare Provider Details

I. General information

NPI: 1710980677
Provider Name (Legal Business Name): TODD S HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD STE 604
NEWPORT BEACH CA
92663-3500
US

IV. Provider business mailing address

PO BOX 12139
NEWPORT BEACH CA
92658-5053
US

V. Phone/Fax

Practice location:
  • Phone: 949-221-0136
  • Fax: 949-387-1136
Mailing address:
  • Phone: 949-221-0136
  • Fax: 949-387-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA105121
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA105121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: