Provider Demographics
NPI:1083259360
Name:HARRISON, LINDA E
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 BROCKTON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3830
Mailing Address - Country:US
Mailing Address - Phone:951-686-3636
Mailing Address - Fax:951-686-9617
Practice Address - Street 1:6950 BROCKTON AVE STE 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3830
Practice Address - Country:US
Practice Address - Phone:951-686-3636
Practice Address - Fax:951-686-9617
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0275665363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics