Healthcare Provider Details

I. General information

NPI: 1235677881
Provider Name (Legal Business Name): ERIN VIERRA FNP-C, PMHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 AERO DR
SAN DIEGO CA
92123-2251
US

IV. Provider business mailing address

8904 SANDMARK AVE
SAN DIEGO CA
92123-3918
US

V. Phone/Fax

Practice location:
  • Phone: 619-400-5170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95094094
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: