MEDICARE: GILLIAN HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	98-69	NM

General Provider Information

NPI Number	:	1396752333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN HARRIS

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 SAN PABLO ST SE STE A
Second Line	:	YOUNG CHILDREN'S HEALTH CENTER
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3167
Country	:	US
Telephone Number	:	505-272-2345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	03/18/2025

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