Provider Demographics
NPI:1962661330
Name:HARRIS, WILLIE ESAU (LVN)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:ESAU
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 W AVENUE J11
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1716
Mailing Address - Country:US
Mailing Address - Phone:666-943-0021
Mailing Address - Fax:661-943-9877
Practice Address - Street 1:6248 W AVENUE J11
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1716
Practice Address - Country:US
Practice Address - Phone:666-943-0021
Practice Address - Fax:661-943-9877
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility