Healthcare Provider Details

I. General information

NPI: 1144671728
Provider Name (Legal Business Name): CRAIG HARRIS CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2016
Last Update Date: 06/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 TUJUNGA AVE STE 150
STUDIO CITY CA
91604-2753
US

IV. Provider business mailing address

4370 TUJUNGA AVE STE 150
STUDIO CITY CA
91604-2753
US

V. Phone/Fax

Practice location:
  • Phone: 818-454-1136
  • Fax: 855-862-5432
Mailing address:
  • Phone: 818-454-1136
  • Fax: 855-862-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: