Provider Demographics
NPI:1922684422
Name:ARCHULETA, ERIC ALEXANDER
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALEXANDER
Last Name:ARCHULETA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 RANCHO DEL ORO DR APT 7
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7303
Mailing Address - Country:US
Mailing Address - Phone:925-818-1091
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE RAIDER BATTALION, MARINE RAIDER REGIMENT
Practice Address - Street 2:555341
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:92055-5341
Practice Address - Country:US
Practice Address - Phone:760-725-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04206971EAOtherUS ARMY, JOHN F. KENNEDY SPECIAL WARFARE CENTER AND SCHOOL