Provider Demographics
NPI:1447662002
Name:HARRIS, PENNY (LAC)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:WEINRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6200 RIVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3810
Mailing Address - Country:US
Mailing Address - Phone:310-498-8071
Mailing Address - Fax:
Practice Address - Street 1:10116 RIVERSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2544
Practice Address - Country:US
Practice Address - Phone:310-498-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist