=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184018079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON EREZ D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2015
-----------------------------------------------------
Last Update Date | 01/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8642 VILLA LA JOLLA DR UNIT, #1
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-2367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-255-0770
-----------------------------------------------------
Fax | 971-228-5412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8642 VILLA LA JOLLA DR UNIT 1
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-2367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-706-0716
-----------------------------------------------------
Fax | 971-228-5412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 186248
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A18844
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------