Provider Demographics
NPI:1760115596
Name:BROGDON, ERIKA SHANELLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:SHANELLE
Last Name:BROGDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 TERMINO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3012
Mailing Address - Country:US
Mailing Address - Phone:951-231-3721
Mailing Address - Fax:
Practice Address - Street 1:2430 W COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4780
Practice Address - Country:US
Practice Address - Phone:562-371-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine