Healthcare Provider Details

I. General information

NPI: 1609722453
Provider Name (Legal Business Name): NIA L HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 THE WOODS DR # F2021
SAN JOSE CA
95136-4601
US

IV. Provider business mailing address

4500 THE WOODS DR # F2021
SAN JOSE CA
95136-4601
US

V. Phone/Fax

Practice location:
  • Phone: 408-569-7774
  • Fax:
Mailing address:
  • Phone: 408-569-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: