MEDICARE: CATHY M HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1265030167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY M HARRIS

Provider Business Mailing Address
First Line	:	160 GLEN COVE MARINA RD STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-648-2000
Fax Number	:	707-648-2300

Provider Business Practice Location Address
First Line	:	160 GLEN COVE MARINA RD STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-648-2000
Fax Number	:	707-648-2300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	07/15/2025

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