Provider Demographics
NPI:1104319474
Name:HARRIS, JENIFFFER WANJIRU
Entity type:Individual
Prefix:
First Name:JENIFFFER
Middle Name:WANJIRU
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENIFFER
Other - Middle Name:W
Other - Last Name:MUITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27614 SPENCER CT APT 102
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6842
Mailing Address - Country:US
Mailing Address - Phone:213-819-5808
Mailing Address - Fax:
Practice Address - Street 1:27614 SPENCER CT APT 102
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-6842
Practice Address - Country:US
Practice Address - Phone:213-819-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist