Organization
SOUTH COAST ALLERGY & ASTHMA MEDICAL CORPORATION.
Active
Other names
WILLIAM G HARRIS MD
Organization subpart
No
Provider details
NPI number
Authorized official
CARMELLA M AMAR (ADMINISTRATOR)
(760) 245-8645
Entity
Organization
Contact information
Practice address
12370 HESPERIA RD, SUITE 1, VICTORVILLE, CA 92395-7719
(760) 245-8645
(760) 245-6798
Mailing address
12370 HESPERIA RD, SUITE 1, VICTORVILLE, CA 92395-7719
(760) 245-8645
(760) 245-6798
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G644932
INDIVIDUAL PTAN
CA
01
—
030003304
RAILROAD MEDICARE
CA
01
—
1922065788
NPI INDIVIDUAL
CA
01
—
1932256211
NPI GROUP
CA
05
—
2112929
—
CA
01
—
BD090Z
GRP PTAN
CA
01
—
ZZZ53231Z
BLUE SHIELD
CA
Enumeration date
01/05/2007
Last updated
01/13/2009
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