Healthcare Provider Details

I. General information

NPI: 1619022167
Provider Name (Legal Business Name): DAVID C. HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD #440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 805-659-1166
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG57789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: