Provider Demographics
NPI:1063063030
Name:HARRIS, CHRISTINA LASHAWN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LASHAWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 E AVENUE K2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4632
Mailing Address - Country:US
Mailing Address - Phone:661-471-5284
Mailing Address - Fax:
Practice Address - Street 1:2542 E AVENUE K2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4632
Practice Address - Country:US
Practice Address - Phone:661-471-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695822164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse