Provider Demographics
NPI:1124554738
Name:FLANAGAN, ERIC JAMES
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:FLANAGAN
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 1:13966 HAMMON PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3456
Mailing Address - Country:US
Mailing Address - Phone:714-404-4930
Mailing Address - Fax:
Practice Address - Street 1:13966 HAMMON PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3456
Practice Address - Country:US
Practice Address - Phone:714-404-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program