Provider Demographics
NPI:1720053846
Name:HARRIS, CHRISTINA V (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:V
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:J
Other - Last Name:VITUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-657-8200
Mailing Address - Fax:858-657-8235
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:858-657-8200
Practice Address - Fax:858-657-8235
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001921363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29490Medicare UPIN
538695Medicare PIN