Healthcare Provider Details

I. General information

NPI: 1174342208
Provider Name (Legal Business Name): ERIN WATERHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 TECHNOLOGY DR
FREMONT CA
94538-6337
US

IV. Provider business mailing address

4914 ANTIOCH ST
UNION CITY CA
94587-5520
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-2350
  • Fax:
Mailing address:
  • Phone: 510-673-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: