Healthcare Provider Details

I. General information

NPI: 1679644876
Provider Name (Legal Business Name): KAREN ANN ERWIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NATIONAL AVE
SAN DIEGO CA
92113-2113
US

IV. Provider business mailing address

8355 STATION VILLAGE LN 4106
SAN DIEGO CA
92108-6572
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax:
Mailing address:
  • Phone: 619-881-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: