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General NPI Number Information
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NPI Number | 1124180989
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Entity Type | Organization
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Legal Business Name | EUGENE HARRIS MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 444 SO SAN VINCENTE BLVD SUITE 603
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City | LOS ANGELES
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State | CA
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Zip | 90048-4165
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Country | US
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Telephone | 310-423-9889
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Fax | 310-423-9891
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Provider Business Mailing Address
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Address Line | 444 SO SAN VINCENTE BLVD SUITE 603
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City | LOS ANGELES
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State | CA
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Zip | 90048-4165
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Country | US
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Telephone | 310-423-9889
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Fax | 310-423-9891
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MYRNA CHARLIN
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Credential |
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Telephone | 310-423-9825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G4367
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License Number State | CA
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