MEDICARE: ERIN SOUZA RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	28723	CA

General Provider Information

NPI Number	:	1184363863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN SOUZA RDH

Provider Business Mailing Address
First Line	:	1732 IVY LN
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-8212
Country	:	US
Telephone Number	:	925-398-3877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 SAN RAMON VALLEY BLVD
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1523
Country	:	US
Telephone Number	:	925-398-3877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/05/2022

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