Active NPI
Ethan Geoffrey Harris, M.D.
- Psychiatry Physician
- Vacaville, CA
National Provider Identifier
1124011689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G18727
- Practice address
- 1119 E Monte Vista Ave
Vacaville, CA 95688-3009 - Phone
- (707) 469-4610
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G18727 | CA | Primary |
Addresses
Primary practice location
1119 E Monte Vista Ave
Vacaville, CA 95688-3009
Mailing address
PO Box 999
13437 Antelope Trail
Oregon House, CA 95962-0999
Phone (530) 692-0802
Other practice location 1
720 Howe Ave Ste 110
Sacramento, CA 95825-4687
Phone (916) 923-0440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G18727 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633564800000",
"number": "1124011689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 999",
"address_2": "13437 ANTELOPE TRAIL",
"city": "OREGON HOUSE",
"state": "CA",
"postal_code": "959620999",
"telephone_number": "530-692-0802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1119 E MONTE VISTA AVE",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956883009",
"telephone_number": "707-469-4610"
}
],
"practiceLocations": [
{
"address_1": "720 Howe Ave Ste 110",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958254687",
"country_code": "US",
"telephone_number": "916-923-0440",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARRIS",
"first_name": "ETHAN",
"middle_name": "GEOFFREY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-30",
"last_updated": "2021-10-07",
"certification_date": "2021-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G18727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.