Provider Demographics
NPI:1467887646
Name:POLLETT, ERIN STACEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:STACEY
Last Name:POLLETT
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 1:2134 VIA SONORA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6348
Mailing Address - Country:US
Mailing Address - Phone:760-803-6922
Mailing Address - Fax:
Practice Address - Street 1:617 VETERANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1404
Practice Address - Country:US
Practice Address - Phone:866-337-2566
Practice Address - Fax:628-777-2580
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant