Healthcare Provider Details

I. General information

NPI: 1114354800
Provider Name (Legal Business Name): MELISA A. ERICK, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

PO BOX 4148
TORRANCE CA
90510-4148
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-885-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG64088
License Number StateCA

VIII. Authorized Official

Name: MELISA A ERICK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-660-9535