Healthcare Provider Details

I. General information

NPI: 1063088920
Provider Name (Legal Business Name): LASHONDA NICOLE HARRIS-BRIDINGER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LASHONDA NICOLE HARRIS LVN

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30865 HIGHLAND VISTA CIR
TEMECULA CA
92591-7264
US

IV. Provider business mailing address

30865 HIGHLAND VISTA CIR
TEMECULA CA
92591-7264
US

V. Phone/Fax

Practice location:
  • Phone: 951-466-7559
  • Fax:
Mailing address:
  • Phone: 951-466-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN712923
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: