Healthcare Provider Details

I. General information

NPI: 1396752333
Provider Name (Legal Business Name): GILLIAN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SAN PABLO ST SE STE A YOUNG CHILDREN'S HEALTH CENTER
ALBUQUERQUE NM
87108-3167
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number98-69
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: