Provider Demographics
NPI:1124651500
Name:O'CONNOR, ERICA RENITA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RENITA
Last Name:O'CONNOR
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 1:14344 CAJON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4301
Mailing Address - Country:US
Mailing Address - Phone:760-243-3999
Mailing Address - Fax:
Practice Address - Street 1:14344 CAJON AVE STE 102
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4301
Practice Address - Country:US
Practice Address - Phone:760-243-3999
Practice Address - Fax:760-256-0537
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide