Healthcare Provider Details

I. General information

NPI: 1285253344
Provider Name (Legal Business Name): ERIN WAINWRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE DEPT OF
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE DEPT OF
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4976
  • Fax:
Mailing address:
  • Phone: 714-509-4976
  • Fax: 714-509-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number187660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: