Healthcare Provider Details

I. General information

NPI: 1053625269
Provider Name (Legal Business Name): FLORENCIA R ERICKSON BA SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FLORENCIA R RUIZ BA SOCIAL WORK

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

1528 E CAROLINE ST
ONTARIO CA
91764-1430
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-8268
  • Fax:
Mailing address:
  • Phone: 909-579-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: