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General NPI Number Information
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NPI Number | 1851634612
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Entity Type | Individual
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Provider Name | KYLE NELSON ERICKSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4150 V ST STE 1110
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City | SACRAMENTO
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State | CA
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Zip | 95817-1460
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Country | US
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Telephone | 916-734-7058
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Fax |
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Provider Business Mailing Address
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Address Line | 18806 N 60TH LN
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City | GLENDALE
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State | AZ
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Zip | 85308-7615
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Country | US
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Telephone | 330-421-7327
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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