Provider Demographics
NPI:1902147861
Name:RANDY S HARRIS MD INC
Entity Type:Organization
Organization Name:RANDY S HARRIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-247-8870
Mailing Address - Street 1:9201 W SUNSET BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3705
Mailing Address - Country:US
Mailing Address - Phone:310-247-8870
Mailing Address - Fax:310-247-9033
Practice Address - Street 1:9201 W SUNSET BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3705
Practice Address - Country:US
Practice Address - Phone:310-247-8870
Practice Address - Fax:310-247-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty