MEDICARE: DR. DARRYL C HARRIS SR. M.D.

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	208VP0000X	Pain Medicine Physician	G88191	CA
2	207QB0002X	Obesity Medicine (Family Medicine) Physician	G88191	CA

General Provider Information

NPI Number	:	1982644415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL C HARRIS SR. M.D.

Provider Business Mailing Address
First Line	:	6230 WILSHIRE BLVD
Second Line	:	SUITE 1251
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5126
Country	:	US
Telephone Number	:	323-549-3420
Fax Number	:	323-375-1341

Provider Business Practice Location Address
First Line	:	2126 S LA BREA AVE
Second Line	:	SUITE 104
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2277
Country	:	US
Telephone Number	:	323-549-3420
Fax Number	:	323-375-1341

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/31/2009

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