Healthcare Provider Details

I. General information

NPI: 1598822884
Provider Name (Legal Business Name): SCOTT R. HARRISON, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE SUITE 205
SANTA ANA CA
92705-3612
US

IV. Provider business mailing address

801 N TUSTIN AVE SUITE 205
SANTA ANA CA
92705-3612
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9100
  • Fax: 714-953-9400
Mailing address:
  • Phone: 714-953-9100
  • Fax: 714-953-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT R. HARRISON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-953-9100