Provider Demographics
NPI:1487189791
Name:HARRIS, FELICITY ALEXIS VANESSA (PA-C)
Entity type:Individual
Prefix:MS
First Name:FELICITY
Middle Name:ALEXIS VANESSA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SAN LEANDRO BLVD APT 1702
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-5060
Mailing Address - Country:US
Mailing Address - Phone:510-393-3118
Mailing Address - Fax:
Practice Address - Street 1:2600 SAN LEANDRO BLVD APT 1702
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-5060
Practice Address - Country:US
Practice Address - Phone:510-393-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant