Provider Demographics
NPI:1205490489
Name:CHILUISA, ERIKA MIREYA
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:MIREYA
Last Name:CHILUISA
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 1:136 SAVOY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4116
Mailing Address - Country:US
Mailing Address - Phone:203-549-8045
Mailing Address - Fax:
Practice Address - Street 1:136 SAVOY ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4116
Practice Address - Country:US
Practice Address - Phone:203-549-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001486251E00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTHCA.0001486OtherHOMECARE AGENCY