Provider Demographics
NPI:1467268615
Name:HARRIS, JEZLYNNE ANNORA
Entity type:Individual
Prefix:MRS
First Name:JEZLYNNE
Middle Name:ANNORA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEZLYNNE
Other - Middle Name:ANNORA
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 E OCEAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7088
Mailing Address - Country:US
Mailing Address - Phone:805-757-5310
Mailing Address - Fax:
Practice Address - Street 1:1025 E OCEAN AVE STE B
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7088
Practice Address - Country:US
Practice Address - Phone:805-757-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator