Provider Demographics
NPI:1104410687
Name:PHELPS, ERICA LIAN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LIAN
Last Name:PHELPS
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 1:5282 MEDICAL DR STE 605
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6114
Mailing Address - Country:US
Mailing Address - Phone:210-447-7373
Mailing Address - Fax:
Practice Address - Street 1:5282 MEDICAL DR STE 605
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6114
Practice Address - Country:US
Practice Address - Phone:210-447-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator