# EUGENE HARRIS MD A PROFESSIONAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124180989
- **Authorized official:** MYRNA CHARLIN (ADMINISTRATOR)
- **Authorized official phone:** (310) 423-9825

## Contact information

- **Practice address:** 444 SO SAN VINCENTE BLVD, SUITE 603, LOS ANGELES, CA 90048-4165
- **Practice address phone:** (310) 423-9889
- **Practice address fax:** (310) 423-9891
- **Mailing address:** 444 SO SAN VINCENTE BLVD, SUITE 603, LOS ANGELES, CA 90048-4165
- **Mailing address phone:** (310) 423-9889
- **Mailing address fax:** (310) 423-9891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G4367 | CA | Yes |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 11/07/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0004123611 | AETNA | CA |
| 01 | — | 000G43670 | BS | CA |
| 05 | — | 000G43670 | — | CA |
| 01 | — | P2260601 | OXFORD | CA |