Provider Demographics
NPI:1053107268
Name:HARRIS, DAMAREA
Entity type:Individual
Prefix:
First Name:DAMAREA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 GAVIOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-1209
Mailing Address - Country:US
Mailing Address - Phone:213-809-1538
Mailing Address - Fax:
Practice Address - Street 1:4825 GAVIOTA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-1209
Practice Address - Country:US
Practice Address - Phone:213-809-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374U00000X, 3747P1801X, 374K00000X, 374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel