Healthcare Provider Details

I. General information

NPI: 1790145522
Provider Name (Legal Business Name): MRS. CAROLINA PILAR HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12155 MAGNOLIA AVE STE 4B
RIVERSIDE CA
92503-4969
US

IV. Provider business mailing address

14140 BEACH BLVD STE 223
WESTMINSTER CA
92683-4453
US

V. Phone/Fax

Practice location:
  • Phone: 951-426-0017
  • Fax: 951-344-0433
Mailing address:
  • Phone: 714-896-7566
  • Fax: 714-896-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: