Provider Demographics
NPI:1427464312
Name:HARRIS, RONALD (ADN)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 E PALM CANYON DR
Mailing Address - Street 2:SUITE 110, #373
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1935
Mailing Address - Country:US
Mailing Address - Phone:442-268-7000
Mailing Address - Fax:
Practice Address - Street 1:2500 N PALM CANYON DR
Practice Address - Street 2:SUITE A4
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1868
Practice Address - Country:US
Practice Address - Phone:442-268-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA838481163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse