Provider Demographics
NPI:1033571153
Name:THURSTON, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:THURSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W OCEAN BLVD APT 6810
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7963
Mailing Address - Country:US
Mailing Address - Phone:954-598-3006
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:11411 BROOKSHIRE AVE STE 207
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5004
Practice Address - Country:US
Practice Address - Phone:562-904-4411
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165574207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine