Healthcare Provider Details

I. General information

NPI: 1043465800
Provider Name (Legal Business Name): ERIKA ELIESE SAMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST BUILDING 128, ROOM A-130
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

9033 SCOTT ST
BELLFLOWER CA
90706-2835
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5969
Mailing address:
  • Phone: 818-389-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7082259
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: