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General NPI Number Information
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NPI Number | 1124422258
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Entity Type | Individual
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Provider Name | GAVIN HARRIS
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Gender | Male
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1801 N OLIVE AVE
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City | TURLOCK
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State | CA
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Zip | 95382-2568
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Country | US
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Telephone | 209-667-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 N QUINCY RD
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City | TURLOCK
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State | CA
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Zip | 95380-2911
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Country | US
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Telephone | 209-202-4994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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