Healthcare Provider Details

I. General information

NPI: 1891618476
Provider Name (Legal Business Name): ERICA LYONS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

2504 HONEY WAY
CONYERS GA
30013-8223
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: