Provider Demographics
NPI:1912953506
Name:HARRIS, PATRICIA F (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UCLA MEDICAL PLZ STE 365
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1693
Mailing Address - Country:US
Mailing Address - Phone:310-206-8272
Mailing Address - Fax:310-794-2113
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 365
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1693
Practice Address - Country:US
Practice Address - Phone:310-206-8272
Practice Address - Fax:310-794-2113
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53546207R00000X, 207RG0300X
DCMD33680207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902846306OtherGROUP NPI
CAGR0100430OtherGROUP MEDICAL
DC034201600Medicaid
VA7604165Medicaid
MD400033100Medicaid
CAW18762OtherGROUP MEDICARE
CAW18762OtherGROUP MEDICARE
CABG594XMedicare PIN
DC010051I17Medicare ID - Type Unspecified