Healthcare Provider Details

I. General information

NPI: 1215256011
Provider Name (Legal Business Name): TAMMI LORRAINE HARRIS N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 03/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9233 W PICO BLVD SUITE 220
LOS ANGELES CA
90035-1386
US

IV. Provider business mailing address

4911 VAN NUYS BLVD SUITE 307
SHERMAN OAKS CA
91403-1716
US

V. Phone/Fax

Practice location:
  • Phone: 310-356-8146
  • Fax: 818-356-8142
Mailing address:
  • Phone: 818-981-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number14292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: