Provider Demographics
NPI:1154801140
Name:HARRIS, PAULYN GAPAY (NP-C)
Entity type:Individual
Prefix:
First Name:PAULYN
Middle Name:GAPAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 ARROW RTE APT V10
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4782
Mailing Address - Country:US
Mailing Address - Phone:909-663-4115
Mailing Address - Fax:
Practice Address - Street 1:10400 ARROW RTE APT V10
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4782
Practice Address - Country:US
Practice Address - Phone:909-663-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty