MEDICARE: SALLY HARRIS CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	156FX1101X	Ophthalmic Assistant	NV
2	211D00000X	Podiatric Assistant	NV
3	246ZX2200X	Orthopedic Assistant	NV
4	246ZC0007X	Surgical Assistant	NV

General Provider Information

NPI Number	:	1538638507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY HARRIS CSFA

Provider Business Mailing Address
First Line	:	3171 W HORN RD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-5041
Country	:	US
Telephone Number	:	775-253-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 GAZING STARS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4773
Country	:	US
Telephone Number	:	702-602-3694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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Directions to “ SALLY HARRIS CSFA” Practice Location

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