Healthcare Provider Details

I. General information

NPI: 1003810409
Provider Name (Legal Business Name): HARRIS HISTOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S B ST
TUSTIN CA
92780-4318
US

IV. Provider business mailing address

630 S B ST
TUSTIN CA
92780-4318
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-4041
  • Fax: 714-832-4127
Mailing address:
  • Phone: 714-832-4041
  • Fax: 714-832-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberHT-009490
License Number StateCA

VIII. Authorized Official

Name: MR. RICK HARRIS
Title or Position: OWNER/CHIEF HISTOTECH
Credential: HT(ASCP)
Phone: 714-832-4041