Provider Demographics
NPI:1629664248
Name:FYFE, ERICA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FYFE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 FOOTHILL BLVD UNIT 137
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2792
Mailing Address - Country:US
Mailing Address - Phone:661-733-3777
Mailing Address - Fax:
Practice Address - Street 1:21726 PLACERITA CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-1235
Practice Address - Country:US
Practice Address - Phone:661-362-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer