Provider Demographics
NPI:1205867421
Name:HARRIS, HARVEY MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:MITCHELL
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 1:2063 AYALA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3712
Mailing Address - Country:US
Mailing Address - Phone:805-648-5106
Mailing Address - Fax:805-830-0347
Practice Address - Street 1:2063 AYALA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3712
Practice Address - Country:US
Practice Address - Phone:805-648-5106
Practice Address - Fax:805-830-0347
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG136382080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7069621Medicaid
AH1452438OtherDEA
A39047Medicare ID - Type Unspecified
A39047Medicare UPIN