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General NPI Number Information
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NPI Number | 1902796204
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Entity Type | Individual
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Provider Name | RYAN SCOTT HARRIS
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 421 N 21ST AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4158
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Country | US
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Telephone | 325-201-5714
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 NE 23RD ST UNIT B
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City | WILTON MANORS
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State | FL
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Zip | 33305-2320
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Country | US
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Telephone | 325-201-5714
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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 | 903502
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License Number State | TX
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