Organization
TONY DEMICO HARRIS MBR
Active
Other names
A-Z PRODUCTS AND SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
TONY HARRIS (CHIEF EXECTIVE OFFICER)
(909) 756-3583
Entity
Organization
Contact information
Practice address
8052 TUSCANY ST, FONTANA, CA 92336-3800
(909) 756-3583
Mailing address
8052 TUSCANY ST, FONTANA, CA 92336-3800
(909) 756-3583
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
177F00000X
Lodging Provider
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
251X00000X
Supports Brokerage Agency
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
302F00000X
Exclusive Provider Organization
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005947
HEALTHCARE ALLIANCE
CA
Enumeration date
07/01/2019
Last updated
07/01/2019
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