Healthcare Provider Details

I. General information

NPI: 1154688000
Provider Name (Legal Business Name): ERISA PRESTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 SILVER SPUR RD SUITE 202
ROLLING HILLS ESTATES CA
90274
US

IV. Provider business mailing address

734 SILVER SPUR RD SUITE 202
ROLLING HILLS ESTATES CA
90274
US

V. Phone/Fax

Practice location:
  • Phone: 424-242-3112
  • Fax:
Mailing address:
  • Phone: 424-242-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: