MEDICARE: NIA L 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	101200000X	Drama Therapist		CA

General Provider Information

NPI Number	:	1609722453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA L HARRIS

Provider Business Mailing Address
First Line	:	4500 THE WOODS DR # F2021
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-4601
Country	:	US
Telephone Number	:	408-569-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 THE WOODS DR # F2021
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-4601
Country	:	US
Telephone Number	:	408-569-7774
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ NIA L HARRIS ” Practice Location

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