Basic Information
| Provider Information | |||||||||
| NPI: | 1164614525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | SUITE C8-222 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | SUITE C8-222 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A100456 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0A1004560 | 05 | CA | MEDICAID |