Provider Demographics
NPI:1871821421
Name:FAIRCHILD, ERIN MARIE
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:MARIE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N BULLIS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1652
Mailing Address - Country:US
Mailing Address - Phone:310-668-9091
Mailing Address - Fax:
Practice Address - Street 1:1315 N BULLIS RD STE 15
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1652
Practice Address - Country:US
Practice Address - Phone:310-668-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner