Healthcare Provider Details

I. General information

NPI: 1992950190
Provider Name (Legal Business Name): ERIN ERASMIA STUDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ERASMIA MAVREDAKIS MD

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY MC 5008
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

9455 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1297
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5818
  • Fax: 858-966-7483
Mailing address:
  • Phone: 858-266-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA105592
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA105592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: