Healthcare Provider Details

I. General information

NPI: 1538694294
Provider Name (Legal Business Name): ERIN HIGGINBOTHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

IV. Provider business mailing address

2829 S GRAND AVE FL 2
LOS ANGELES CA
90007-3304
US

V. Phone/Fax

Practice location:
  • Phone: 213-699-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA161809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: