Provider Demographics
NPI:1801866082
Name:HARRIS, PAMELA D
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:D
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 1:4917 STIRRUP WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8170
Mailing Address - Country:US
Mailing Address - Phone:925-777-0348
Mailing Address - Fax:866-584-2751
Practice Address - Street 1:4917 STIRRUP WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8170
Practice Address - Country:US
Practice Address - Phone:925-777-0348
Practice Address - Fax:866-584-2751
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor