Provider Demographics
NPI:1003810409
Name:HARRIS HISTOLOGY SERVICES
Entity Type:Organization
Organization Name:HARRIS HISTOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF HISTOTECH
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:HT(ASCP)
Authorized Official - Phone:714-832-4041
Mailing Address - Street 1:630 S B ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4318
Mailing Address - Country:US
Mailing Address - Phone:714-832-4041
Mailing Address - Fax:714-832-4127
Practice Address - Street 1:630 S B ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4318
Practice Address - Country:US
Practice Address - Phone:714-832-4041
Practice Address - Fax:714-832-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT-009490291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX05D000001Medicare ID - Type UnspecifiedPART B MEDICARE