Healthcare Provider Details

I. General information

NPI: 1538638507
Provider Name (Legal Business Name): SALLY HARRIS CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 GAZING STARS ST
NORTH LAS VEGAS NV
89030-4773
US

IV. Provider business mailing address

3171 W HORN RD
PAHRUMP NV
89048-5041
US

V. Phone/Fax

Practice location:
  • Phone: 702-602-3694
  • Fax:
Mailing address:
  • Phone: 775-253-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code211D00000X
TaxonomyPodiatric Assistant
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: