Provider Demographics
NPI:1467734079
Name:HARRIS-CHAVEZ, LISA RENEE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENEE
Last Name:HARRIS-CHAVEZ
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 1:3870 ROSIN CT
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1620
Mailing Address - Country:US
Mailing Address - Phone:916-363-1553
Mailing Address - Fax:
Practice Address - Street 1:9261 FOLSOM BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2561
Practice Address - Country:US
Practice Address - Phone:916-441-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program