Basic Information
| Provider Information | |||||||||
| NPI: | 1457592586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | DTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24451 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498374500 | ||||||||
| FaxNumber: | 9494523436 | ||||||||
| Practice Location | |||||||||
| Address1: | 24451 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498374500 | ||||||||
| FaxNumber: | 9494523436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2009 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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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 | 136A00000X | Y | Dietary & Nutritional Service Providers | Dietetic Technician, Registered |
No ID Information.