Provider Demographics
NPI:1962808477
Name:AMTHOR, ERIKA LEE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:LEE
Last Name:AMTHOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1593 ROBIN MARIE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1783
Mailing Address - Country:US
Mailing Address - Phone:951-905-8356
Mailing Address - Fax:
Practice Address - Street 1:7095 INDIANA AVE STE 210
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4159
Practice Address - Country:US
Practice Address - Phone:951-222-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52138OtherSTATE OF CALIFORNIA