Provider Demographics
NPI:1861614299
Name:DEC, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34145 PACIFIC COAST HWY # 803
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2808
Mailing Address - Country:US
Mailing Address - Phone:949-632-2704
Mailing Address - Fax:
Practice Address - Street 1:34145 PACIFIC COAST HWY # 803
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2808
Practice Address - Country:US
Practice Address - Phone:949-632-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108036207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00032570Medicaid
MS00032570Medicaid