Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP16765 | CA |
NPI | 1023177912 |
---|---|
Provider Name | Mrs. Erica Eckroad Mason |
First Address | Oakland, CA 94601 |
Second Address | Oakland, CA 94601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |