Healthcare Provider Details

I. General information

NPI: 1417308560
Provider Name (Legal Business Name): DARA HARRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BEALE ST 12TH FLOOR
SAN FRANCISCO CA
94105-1813
US

IV. Provider business mailing address

9320 117TH AVE
LARGO FL
33773-4343
US

V. Phone/Fax

Practice location:
  • Phone: 415-615-4214
  • Fax:
Mailing address:
  • Phone: 415-615-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 580973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: