Provider Demographics
NPI: | 1659725729 |
---|---|
Name: | HARRIS, GBOLAHAN (RRT) |
Entity Type: | Individual |
Prefix: | |
First Name: | GBOLAHAN |
Middle Name: | |
Last Name: | HARRIS |
Suffix: | |
Gender: | M |
Credentials: | RRT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1300 W 19TH ST |
Mailing Address - Street 2: | 7774 |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77008-1689 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-964-6216 |
Mailing Address - Fax: | 832-964-6216 |
Practice Address - Street 1: | 1241 W 17TH ST |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77008-3439 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-964-6216 |
Practice Address - Fax: | 832-964-6216 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-04-14 |
Last Update Date: | 2016-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 62233 | 227900000X, 2279C0205X, 2279E1000X, 2279G1100X, 2279H0200X, 2279P3800X, 2279P3900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | |
No | 2279C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Critical Care |
No | 2279E1000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Educational |
No | 2279G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | General Care |
No | 2279H0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Home Health |
No | 2279P3800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Palliative/Hospice |
No | 2279P3900X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Neonatal/Pediatrics |