Provider Demographics
NPI:1013046143
Name:ERB, MIRIAM E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:E
Last Name:ERB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:ERB
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4024 IBIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1840
Mailing Address - Country:US
Mailing Address - Phone:619-296-6757
Mailing Address - Fax:619-287-3174
Practice Address - Street 1:4024 IBIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1840
Practice Address - Country:US
Practice Address - Phone:619-296-6757
Practice Address - Fax:619-287-3174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPL54970Medicaid
CAPL54970Medicaid
CACP5497Medicare ID - Type Unspecified