Provider Demographics
NPI:1124369764
Name:HARRIS, LUZERO M
Entity Type:Individual
Prefix:
First Name:LUZERO
Middle Name:M
Last Name:HARRIS
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 1:2741 W BIRD RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-3805
Mailing Address - Country:US
Mailing Address - Phone:520-908-0931
Mailing Address - Fax:520-296-8244
Practice Address - Street 1:2741 W BIRD RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-3805
Practice Address - Country:US
Practice Address - Phone:520-908-0931
Practice Address - Fax:520-296-8244
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12185385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12185OtherOLCR LICENSE