Healthcare Provider Details

I. General information

NPI: 1306263470
Provider Name (Legal Business Name): ERIC LAMARCA ORTHO TECHNOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR SUITE 125
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

4510 EXECUTIVE DR SUITE 125
SAN DIEGO CA
92121-3021
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-0455
  • Fax: 858-678-0391
Mailing address:
  • Phone: 858-678-0455
  • Fax: 858-678-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHT00103971
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number13-0200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: