Healthcare Provider Details

I. General information

NPI: 1093634230
Provider Name (Legal Business Name): JAMIE HARNESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 FALL CREEK CT
FAIRFIELD CA
94534-6637
US

IV. Provider business mailing address

2158 BRIDGEPORT AVE
FAIRFIELD CA
94534-1602
US

V. Phone/Fax

Practice location:
  • Phone: 707-863-0125
  • Fax: 707-638-0398
Mailing address:
  • Phone: 707-863-0125
  • Fax: 707-638-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: