Healthcare Provider Details

I. General information

NPI: 1790064475
Provider Name (Legal Business Name): ERIK MAURICIO FARIAS MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 BEATTY DR
RIVERSIDE CA
92506-2307
US

IV. Provider business mailing address

4746 BEATTY DR
RIVERSIDE CA
92506-2307
US

V. Phone/Fax

Practice location:
  • Phone: 951-522-5698
  • Fax:
Mailing address:
  • Phone: 951-522-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: