Provider Demographics
NPI:1922395532
Name:VYAS, HARISH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:M
Last Name:VYAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25601 JERONIMO RD
Mailing Address - Street 2:T2163
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2794
Mailing Address - Country:US
Mailing Address - Phone:949-680-1065
Mailing Address - Fax:949-680-1075
Practice Address - Street 1:25601 JERONIMO RD
Practice Address - Street 2:T2163
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2794
Practice Address - Country:US
Practice Address - Phone:949-680-1065
Practice Address - Fax:949-680-1075
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist