Provider Demographics
NPI:1841088184
Name:HARRIS, DENITRA S (LVN)
Entity type:Individual
Prefix:MRS
First Name:DENITRA
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:DENITRA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2383 CARDINAL DR APT 30
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4113
Mailing Address - Country:US
Mailing Address - Phone:678-548-0820
Mailing Address - Fax:
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1147
Practice Address - Country:US
Practice Address - Phone:619-966-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732899164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse