1124414255 NPI number — MRS. DONNA M. HARRIS M.A. MARRIAGE FAMILY

Table of content: MRS. DONNA M. HARRIS M.A. MARRIAGE FAMILY (NPI 1124414255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124414255 NPI number — MRS. DONNA M. HARRIS M.A. MARRIAGE FAMILY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
DONNA
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. MARRIAGE FAMILY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124414255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1961 MAIN STREET
Provider Second Line Business Mailing Address:
UPS STORE, PERSONAL MAIL BOX 295
Provider Business Mailing Address City Name:
WATSONVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-227-7533
Provider Business Mailing Address Fax Number:
831-647-1498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 CASS ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-227-7533
Provider Business Practice Location Address Fax Number:
831-647-1498
Provider Enumeration Date:
04/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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