Provider Demographics
NPI:1194033415
Name:KAHEAKU-ENHADA, ERIKA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:M
Last Name:KAHEAKU-ENHADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 BREAKAWAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1912
Mailing Address - Country:US
Mailing Address - Phone:858-735-0790
Mailing Address - Fax:
Practice Address - Street 1:2450 CRAVEN ST BLDG 3300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5599
Practice Address - Country:US
Practice Address - Phone:858-556-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194033415OtherNPI