Healthcare Provider Details

I. General information

NPI: 1447313713
Provider Name (Legal Business Name): VICKI JO HARRIS RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 SAN JOSE AVE
ALAMEDA CA
94501-4834
US

IV. Provider business mailing address

1271 WASHINGTON AVE 810
SAN LEANDRO CA
94577-3646
US

V. Phone/Fax

Practice location:
  • Phone: 510-227-5804
  • Fax: 510-227-5804
Mailing address:
  • Phone: 510-227-5804
  • Fax: 510-227-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP44
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: