Provider Demographics
NPI:1316914179
Name:HARRIS, RICHARD ERNEST (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERNEST
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16955 VIA DEL CAMPO
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-7720
Mailing Address - Country:US
Mailing Address - Phone:858-673-6100
Mailing Address - Fax:858-673-6113
Practice Address - Street 1:8945 MAGNOLIA AVE
Practice Address - Street 2:#200 GLENWOOD SURGERY CENTER
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-688-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34175207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C341750Medicaid
CA00C341754Medicare ID - Type Unspecified
CA00C341750Medicaid