Healthcare Provider Details

I. General information

NPI: 1013340975
Provider Name (Legal Business Name): ERIN ELMORE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 LA MESA BLVD
LA MESA CA
91942
US

IV. Provider business mailing address

8355 LA MESA BLVD
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 858-999-5429
  • Fax:
Mailing address:
  • Phone: 858-999-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY29511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: