Provider Demographics
NPI:1700354024
Name:MCDONNELL, ERICA AMBER (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:AMBER
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4641
Mailing Address - Country:US
Mailing Address - Phone:707-246-9583
Mailing Address - Fax:
Practice Address - Street 1:2325 3RD ST STE 342
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-4302
Practice Address - Country:US
Practice Address - Phone:415-861-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist