Provider Demographics
NPI:1356367759
Name:ERBA, DOMINIC M (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:M
Last Name:ERBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 COTTONWOOD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5131
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:
Practice Address - Street 1:1321 COTTONWOOD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5131
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37497208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G374970OtherBLUE SHIELD
CA020017979OtherRR MEDICARE
CA00G374970Medicaid
CA00G374970OtherBLUE SHIELD
A47115Medicare UPIN
CA00G374971Medicare PIN