Provider Demographics
NPI:1114701588
Name:DOO, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DOO
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 1:6386 ALVARADO CT STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4908
Mailing Address - Country:US
Mailing Address - Phone:619-668-6200
Mailing Address - Fax:619-668-6202
Practice Address - Street 1:6386 ALVARADO CT STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4908
Practice Address - Country:US
Practice Address - Phone:619-668-6200
Practice Address - Fax:619-668-6202
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No172V00000XOther Service ProvidersCommunity Health Worker