=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043465800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA ELIESE SAMPSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2008
-----------------------------------------------------
Last Update Date | 08/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 E 7TH ST BUILDING 128, ROOM A-130
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90822-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-826-8000
-----------------------------------------------------
Fax | 562-826-5969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9033 SCOTT ST
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-389-5044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7082259
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------