Provider Demographics
NPI:1184363863
Name:SOUZA, ERIN (RDH)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SOUZA-CABRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FDN-P
Mailing Address - Street 1:1732 IVY LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8212
Mailing Address - Country:US
Mailing Address - Phone:925-398-3877
Mailing Address - Fax:
Practice Address - Street 1:2355 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1523
Practice Address - Country:US
Practice Address - Phone:925-398-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28723124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist