Provider Demographics
NPI:1558505115
Name:XAVIER, ERYN M (MD)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:M
Last Name:XAVIER
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 1:1201 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5238
Mailing Address - Country:US
Mailing Address - Phone:916-739-1007
Mailing Address - Fax:916-731-7815
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-739-1007
Practice Address - Fax:916-731-7815
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA113460390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program