Provider Demographics
NPI:1427189596
Name:HARRIS, THERESA DAWN
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DAWN
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:PO BOX 1559
Mailing Address - Street 2:ATTENTION ANN LEE CLINICA SIERRA VISTA
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:3717 MT PINOS WAY
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225
Practice Address - Country:US
Practice Address - Phone:661-245-0250
Practice Address - Fax:661-245-0252
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator