Provider Demographics
NPI:1528647948
Name:CHAO, ERICA (DACM, LAC, CMT, LLC)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:DACM, LAC, CMT, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 LELAND ST APT D2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1044
Mailing Address - Country:US
Mailing Address - Phone:240-515-0006
Mailing Address - Fax:
Practice Address - Street 1:3920 LELAND ST APT D2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1044
Practice Address - Country:US
Practice Address - Phone:240-515-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CA19084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist