Healthcare Provider Details

I. General information

NPI: 1174047765
Provider Name (Legal Business Name): ERICA CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12139 MOUNT VERNON AVE STE 110
GRAND TERRACE CA
92313-5500
US

IV. Provider business mailing address

25677 HURON ST
LOMA LINDA CA
92354-3702
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-3396
  • Fax: 909-783-4288
Mailing address:
  • Phone: 858-805-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: