Basic Information
Provider Information
NPI: 1790048957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POAST
FirstName: ERIK
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2020 GENESEE AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921234219
CountryCode: US
TelephoneNumber: 8586168400
FaxNumber: 8586168420
Practice Location
Address1: 2020 GENESEE AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921234219
CountryCode: US
TelephoneNumber: 8586168400
FaxNumber: 8586168420
Other Information
ProviderEnumerationDate: 06/21/2012
LastUpdateDate: 11/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA22148CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


Home