Provider Demographics
NPI:1457461436
Name:HARRIS, RONALD DAVID (RONALD HARRIS, MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAVID
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RONALD HARRIS, MD
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:D
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RONALD HARRIS, MD
Mailing Address - Street 1:1020 GENTER ST
Mailing Address - Street 2:# 102
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5542
Mailing Address - Country:US
Mailing Address - Phone:858-459-9564
Mailing Address - Fax:858-459-9561
Practice Address - Street 1:1020 GENTER ST
Practice Address - Street 2:# 102
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5542
Practice Address - Country:US
Practice Address - Phone:858-459-9564
Practice Address - Fax:858-459-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist