Healthcare Provider Details

I. General information

NPI: 1285917120
Provider Name (Legal Business Name): ERDIRECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 LA SALLE AVE SUITE 741
OAKLAND CA
94611-2802
US

IV. Provider business mailing address

6114 LA SALLE AVE SUITE 741
OAKLAND CA
94611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 800-756-4206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA104178
License Number StateCA

VIII. Authorized Official

Name: MR. SEAN EDWARD PARKIN
Title or Position: PRESIDENT
Credential: PA-C
Phone: 415-671-9615