Basic Information
| Provider Information | |||||||||
| NPI: | 1174563399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 N 1ST AVE | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268211411 | ||||||||
| FaxNumber: | 6268210406 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W CALIFORNIA BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263975139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A82334 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | A82334 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 00A823340 | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER | 1174563399 | 05 | CA | MEDICAID |