Provider Demographics
NPI:1649419482
Name:HARRIS, ANDREW ALFRED (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALFRED
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2609
Mailing Address - Country:US
Mailing Address - Phone:909-591-6446
Mailing Address - Fax:909-591-1309
Practice Address - Street 1:5475 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2609
Practice Address - Country:US
Practice Address - Phone:909-591-6446
Practice Address - Fax:909-591-3909
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical