Provider Demographics
NPI:1467180315
Name:WALL, ERICA ZIEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ZIEL
Last Name:WALL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 DRIFTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1083
Mailing Address - Country:US
Mailing Address - Phone:989-780-6068
Mailing Address - Fax:
Practice Address - Street 1:2400 S C ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4555
Practice Address - Country:US
Practice Address - Phone:805-240-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant