Provider Demographics
NPI:1003568932
Name:KING, ERIK RAFAEL
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:RAFAEL
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 N STEELDUST TRL
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5120
Mailing Address - Country:US
Mailing Address - Phone:623-698-7722
Mailing Address - Fax:
Practice Address - Street 1:1345 N STEELDUST TRL
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5120
Practice Address - Country:US
Practice Address - Phone:623-698-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty