Healthcare Provider Details

I. General information

NPI: 1518536119
Provider Name (Legal Business Name): ERIN CATHLEEN DUFFY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 41ST AVE STE C
CAPITOLA CA
95010-2516
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-684-7611
  • Fax: 831-477-2009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: