Provider Demographics
NPI:1538860507
Name:HARRISON, ZACHARIAH
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MONTE VISTA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6604
Mailing Address - Country:US
Mailing Address - Phone:909-865-9501
Mailing Address - Fax:909-469-2146
Practice Address - Street 1:3110 CHINO AVE STE 150A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1295
Practice Address - Country:US
Practice Address - Phone:909-630-7940
Practice Address - Fax:909-469-2108
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA65082363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical