Provider Demographics
NPI:1700086329
Name:HARRIS-CARRIMAN, STACEY L (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:HARRIS-CARRIMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6247
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-0247
Mailing Address - Country:US
Mailing Address - Phone:510-393-4060
Mailing Address - Fax:
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:7TH FLOOR, ARU
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91115208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADQ904AMedicare PIN