Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 49749 | CA |
NPI | 1013006006 |
---|---|
Provider Name | Michael John Erickson |
First Address | Murrieta, CA 92562-2541 |
Second Address | Vista, CA 92084-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |