Healthcare Provider Details

I. General information

NPI: 1811491194
Provider Name (Legal Business Name): ERIC AASERUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4000
  • Fax:
Mailing address:
  • Phone: 925-295-4000
  • Fax: 220-564-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57.246252
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number194406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: