Healthcare Provider Details

I. General information

NPI: 1528010279
Provider Name (Legal Business Name): SHARON B. HARRIS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42121 US HWY 70
PORTALES NM
88130-9347
US

IV. Provider business mailing address

PO BOX 299
PORTALES NM
88130-9347
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-6652
  • Fax: 575-226-0099
Mailing address:
  • Phone: 575-356-6652
  • Fax: 575-226-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number072
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: