Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | CA |
NPI | 1083863088 |
---|---|
Provider Name | Stacie Lorraine Harris |
First Address | Anaheim, CA 92804-4037 |
Second Address | Anaheim, CA 92804-4037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |