Healthcare Provider Details

I. General information

NPI: 1184408908
Provider Name (Legal Business Name): ERICA G TILLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42455 10TH ST W STE 103
LANCASTER CA
93534-7060
US

IV. Provider business mailing address

42455 10TH ST W STE 103
LANCASTER CA
93534-7060
US

V. Phone/Fax

Practice location:
  • Phone: 213-655-6281
  • Fax:
Mailing address:
  • Phone: 213-665-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: