Individual
DIANE I. HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
850 SEQUOIA CIR, FORT BRAGG, CA 95437-5490
(707) 964-0259
(707) 964-0765
Mailing address
850 SEQUOIA CIR, FORT BRAGG, CA 95437-5490
(707) 964-0259
(707) 964-0765
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G44893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G448930
MEDI-CAL
CA
Enumeration date
08/11/2006
Last updated
11/02/2015
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