Provider Demographics
NPI:1396477741
Name:HARRIS, VALERIAN RAY
Entity type:Individual
Prefix:
First Name:VALERIAN
Middle Name:RAY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:VALENTINA
Other - Last Name:DEPUY-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8414 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7104
Mailing Address - Country:US
Mailing Address - Phone:907-232-9203
Mailing Address - Fax:
Practice Address - Street 1:1225 NW MURRAY RD STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5572
Practice Address - Country:US
Practice Address - Phone:503-643-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-25
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No175T00000XOther Service ProvidersPeer Specialist