Provider Demographics
NPI:1609915768
Name:WASSER, HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:
Last Name:WASSER
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062
Mailing Address - Country:US
Mailing Address - Phone:805-376-2649
Mailing Address - Fax:805-376-2649
Practice Address - Street 1:2950 N SYCAMORE DR #200
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-522-4004
Practice Address - Fax:805-583-3709
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 37142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371421Medicaid
A 28313Medicare UPIN
CAA 37142AMedicare ID - Type Unspecified