Healthcare Provider Details

I. General information

NPI: 1255012548
Provider Name (Legal Business Name): ERICA MA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

IV. Provider business mailing address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

V. Phone/Fax

Practice location:
  • Phone: 650-766-3753
  • Fax:
Mailing address:
  • Phone: 650-766-3753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: