Healthcare Provider Details

I. General information

NPI: 1396934188
Provider Name (Legal Business Name): ALEX T HARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E MAIN ST SUITE 101
SANTA MARIA CA
93454-4825
US

IV. Provider business mailing address

1510 E MAIN ST SUITE 101
SANTA MARIA CA
93454-4825
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-0610
  • Fax: 805-928-0680
Mailing address:
  • Phone: 805-928-0610
  • Fax: 805-928-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA89322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: