Provider Demographics
NPI:1326044769
Name:ERICKSON, AMELIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:A
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 N. PALO VERDE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-596-1015
Mailing Address - Fax:
Practice Address - Street 1:2925 N. PALO VERDE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:714-964-6229
Practice Address - Fax:714-378-6233
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G647040OtherMEDI CAL #
CA00G647040OtherMEDI CAL #