Provider Demographics
NPI:1093006439
Name:HARRIS, MARINA ALEKSANDROVNA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:ALEKSANDROVNA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:ALEKSANDROVNA
Other - Last Name:SHVARTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11003 RESOURCE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6142
Mailing Address - Country:US
Mailing Address - Phone:281-481-8557
Mailing Address - Fax:281-481-8540
Practice Address - Street 1:11003 RESOURCE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6142
Practice Address - Country:US
Practice Address - Phone:281-481-8557
Practice Address - Fax:281-481-8540
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1651363AM0700X, 363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1175PAMedicaid
SC1175PAMedicaid