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General NPI Number Information
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NPI Number | 1164812855
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Entity Type | Individual
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Provider Name | ERICA VICTORIA JOHNSON-HERRERA OT
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 9540 TOWNE CENTRE DR SUITE 150
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City | SAN DIEGO
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State | CA
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Zip | 92121-1988
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Country | US
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Telephone | 858-952-1654
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Fax |
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Provider Business Mailing Address
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Address Line | 6424 N RIDGE BLVD APT 2H
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City | CHICAGO
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State | IL
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Zip | 60626-4832
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Country | US
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Telephone | 510-277-2145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 056.010629
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License Number State | IL
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