Provider Demographics
NPI:1992401723
Name:HARRIS, AVROHOM (CM)
Entity type:Individual
Prefix:
First Name:AVROHOM
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6523 52ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3401
Mailing Address - Country:US
Mailing Address - Phone:856-291-1873
Mailing Address - Fax:
Practice Address - Street 1:6523 52ND AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3401
Practice Address - Country:US
Practice Address - Phone:856-291-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZLSC054374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner