Healthcare Provider Details

I. General information

NPI: 1891344990
Provider Name (Legal Business Name): TIMOTHY HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ANGELES VISTA BLVD
VIEW PARK CA
90043-1648
US

IV. Provider business mailing address

1126 N GRAND AVE
COVINA CA
91724-1551
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: