Healthcare Provider Details

I. General information

NPI: 1134690613
Provider Name (Legal Business Name): ERIN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 OXFORD DR APT D
REDLANDS CA
92374-3492
US

IV. Provider business mailing address

1129 OXFORD DR APT D
REDLANDS CA
92374-3492
US

V. Phone/Fax

Practice location:
  • Phone: 909-486-0485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number739533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: