Provider Demographics
NPI:1184122467
Name:BESERRA, ERIKA GUADALUPE
Entity type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:GUADALUPE
Last Name:BESERRA
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 1:4016 NW WITHAM HILL DR APT 67
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1634
Mailing Address - Country:US
Mailing Address - Phone:626-941-4027
Mailing Address - Fax:
Practice Address - Street 1:4016 NW WITHAM HILL DR APT 67
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1634
Practice Address - Country:US
Practice Address - Phone:626-941-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer