Healthcare Provider Details

I. General information

NPI: 1700413317
Provider Name (Legal Business Name): HARRIS AHMED DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36949 COOK ST STE A101
PALM DESERT CA
92211-6079
US

IV. Provider business mailing address

555 N 13TH AVE
UPLAND CA
91786-4904
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-2394
  • Fax: 760-340-2369
Mailing address:
  • Phone: 800-345-8979
  • Fax: 909-949-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number327794
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number20A19818
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20A19818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: