Healthcare Provider Details

I. General information

NPI: 1134436710
Provider Name (Legal Business Name): MELISSA SHERRI HARREN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

17861 VIA LA CRESTA
CHINO HILLS CA
91709-3914
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4666
  • Fax:
Mailing address:
  • Phone: 909-248-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN222628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: