Healthcare Provider Details

I. General information

NPI: 1407751449
Provider Name (Legal Business Name): KATIE VINCENE HARRIS I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GREEN RIVER RD STE 204
CORONA CA
92878-9434
US

IV. Provider business mailing address

44684 STATE HIGHWAY 74 APT 1
HEMET CA
92544-5922
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-1793
  • Fax: 502-297-0289
Mailing address:
  • Phone: 562-665-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: