Basic Information
| Provider Information | |||||||||
| NPI: | 1174055875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAMBA | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | KANNA | ||||||||
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| Credential: | D.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3348 LA MESA DR | ||||||||
| Address2: | #2 | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2258024040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 SHOREWAY RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940702788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505569420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2017 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 292837 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.