1801314042 NPI number — ERIKA DIMITRA COURIS PA-C

Table of content: ERIKA DIMITRA COURIS PA-C (NPI 1801314042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801314042 NPI number — ERIKA DIMITRA COURIS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURIS
Provider First Name:
ERIKA
Provider Middle Name:
DIMITRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801314042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3260 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-865-4867
Provider Business Mailing Address Fax Number:
619-291-0049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3969 FOURTH AVE
Provider Second Line Business Practice Location Address:
#301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-9210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-6191
Provider Business Practice Location Address Fax Number:
619-291-6191
Provider Enumeration Date:
09/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  13978 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com