Provider Demographics
NPI:1104107572
Name:TUMBAGA, ERICA L
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:TUMBAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 HUNTINGTON DR # 4S
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5620
Mailing Address - Country:US
Mailing Address - Phone:213-484-1186
Mailing Address - Fax:213-353-1119
Practice Address - Street 1:521 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2148
Practice Address - Country:US
Practice Address - Phone:213-622-0867
Practice Address - Fax:213-622-1801
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical