1952694408 NPI number — DR. ERIKA SWIFT HOLTERMANN PHD

Table of content: DR. ERIKA SWIFT HOLTERMANN PHD (NPI 1952694408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952694408 NPI number — DR. ERIKA SWIFT HOLTERMANN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLTERMANN
Provider First Name:
ERIKA
Provider Middle Name:
SWIFT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURGESS
Provider Other First Name:
ERIKA
Provider Other Middle Name:
SWIFT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952694408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18673 WESSEX ST
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:
92128-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-243-3245
Provider Business Mailing Address Fax Number:
858-217-6973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15525 POMERADO RD
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-243-3245
Provider Business Practice Location Address Fax Number:
858-217-6919
Provider Enumeration Date:
05/17/2011

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: 103TC0700X , with the licence number:  24132 , 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)





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