Individual
KENNETH A HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CCRN
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5305
(510) 537-1234
Mailing address
165 COOSADA LN, COOSADA, AL 36020-2919
(334) 268-9220
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
782137
CA
163WG0000X
General Practice Registered Nurse
1-105100
AL
Other
Enumeration date
09/21/2020
Last updated
11/27/2023
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