Healthcare Provider Details

I. General information

NPI: 1427217793
Provider Name (Legal Business Name): DEBORA LIZ HARRISON RCFE LICENCEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 MYSTIC MINE TRAIL
BROWNSVILLE CA
95919
US

IV. Provider business mailing address

PO BOX 59
BROWNSVILLE CA
95919-0059
US

V. Phone/Fax

Practice location:
  • Phone: 530-675-3640
  • Fax:
Mailing address:
  • Phone: 530-675-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberRCFE# 585002011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: