Healthcare Provider Details

I. General information

NPI: 1891520102
Provider Name (Legal Business Name): ERICA KIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD
SANTA FE SPGS CA
90670-3674
US

IV. Provider business mailing address

1000 W CARSON ST # 488
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-8455
  • Fax:
Mailing address:
  • Phone: 424-306-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: