Healthcare Provider Details

I. General information

NPI: 1801361993
Provider Name (Legal Business Name): ERICA TRISTAN NEUBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA T WILLIAMS

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE STE 300
LA JOLLA CA
92037-1215
US

IV. Provider business mailing address

4022 LAMONT ST APT 1
SAN DIEGO CA
92109-6285
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-2900
  • Fax:
Mailing address:
  • Phone: 619-787-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: