Provider Demographics
NPI:1619480464
Name:JOHNSON, ERICA MICHELLE GUAJARDO (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE GUAJARDO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:ERI
Other - Middle Name:GUAJARDO
Other - Last Name:JOHNSON-DAUGHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22750 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22750 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3308
Practice Address - Country:US
Practice Address - Phone:734-904-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula