Provider Demographics
NPI:1194033415
Name:KAHEAKU-ENHADA, ERIKA M (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:M
Last Name:KAHEAKU-ENHADA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D SUSTAINMENT GROUP EXPERIMENTAL
Mailing Address - Street 2:OPC 558 BOX 52
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96375
Mailing Address - Country:US
Mailing Address - Phone:315-637-1564
Mailing Address - Fax:
Practice Address - Street 1:2450 CRAVEN ST BLDG 3300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5599
Practice Address - Country:US
Practice Address - Phone:858-556-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194033415OtherNPI