Healthcare Provider Details

I. General information

NPI: 1629845854
Provider Name (Legal Business Name): JENNIFER HARRIS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # 3-524
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

11203 CARMEL CREEK RD UNIT 4
SAN DIEGO CA
92130-2630
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-6376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number4675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: