Provider Demographics
NPI:1952860512
Name:DALY, ERIKA GIANNA
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:GIANNA
Last Name:DALY
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 1:1358 S DIAMOND BAR BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-5465
Mailing Address - Country:US
Mailing Address - Phone:909-781-3591
Mailing Address - Fax:
Practice Address - Street 1:1358 S DIAMOND BAR BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-5465
Practice Address - Country:US
Practice Address - Phone:909-781-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty