Provider Demographics
NPI:1619996105
Name:ERICKSON, SONIA ELIZABETH (DPM)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:ELIZABETH
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 W LAS POSITAS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5805
Mailing Address - Country:US
Mailing Address - Phone:925-416-0990
Mailing Address - Fax:
Practice Address - Street 1:5565 W LAS POSITAS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5805
Practice Address - Country:US
Practice Address - Phone:925-416-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4382213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95898Medicare UPIN
CA000E43820Medicare ID - Type Unspecified