Provider Demographics
NPI:1760084768
Name:HARRIS, CLAUDIA MARIA (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TOD LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2637
Mailing Address - Country:US
Mailing Address - Phone:234-855-1882
Mailing Address - Fax:
Practice Address - Street 1:70 TOD LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2637
Practice Address - Country:US
Practice Address - Phone:234-855-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02775303747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277530Medicaid