Provider Demographics
NPI:1487678827
Name:HARRISON, JAMES ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALVIN
Last Name:HARRISON
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 1:24318 HEMLOCK AVE
Mailing Address - Street 2:SUITE # E1
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7222
Mailing Address - Country:US
Mailing Address - Phone:951-243-5050
Mailing Address - Fax:951-243-5586
Practice Address - Street 1:24318 HEMLOCK AVE
Practice Address - Street 2:SUITE # E1
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7222
Practice Address - Country:US
Practice Address - Phone:951-243-5050
Practice Address - Fax:951-243-5586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43499261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A434990Medicaid
CA00A434992Medicare ID - Type Unspecified
CAH69412Medicare UPIN