Healthcare Provider Details

I. General information

NPI: 1154769453
Provider Name (Legal Business Name): ERIN PATRICIA WARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC XXXX
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

4629 W POINT LOMA BLVD
SAN DIEGO CA
92107-1424
US

V. Phone/Fax

Practice location:
  • Phone: 619-471-3859
  • Fax:
Mailing address:
  • Phone: 517-648-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12960240-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number12960240-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: