Provider Demographics
NPI:1194004416
Name:HARRIS, BERNARD N (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:N
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-3034
Mailing Address - Country:US
Mailing Address - Phone:310-393-7758
Mailing Address - Fax:310-393-7758
Practice Address - Street 1:502 21ST ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-3034
Practice Address - Country:US
Practice Address - Phone:310-393-7758
Practice Address - Fax:310-393-7758
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE025308208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACFE025308OtherCALIFORNIA BOARD OF MEDICAL EXAMINERS