Licea, Erica Berenice
Licea, Erica Berenice is an individual health care provider with primary practice located at 1342 W La Gloria Dr , Rialto CA 92377-4466. She recently has only one registered license in Dental Providers / Dental Assistant, which is considered as her primary health care specialty. Licea, Erica Berenice can be contacted via phone (951) 465-9162.Contact Information
Primary practice address
1342 W La Gloria Dr
Rialto CA 92377-4466
Phone: (951) 465-9162
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Assistant | 126800000X | 66604 | California |
Profile Details
| NPI number | 1376002287 |
|---|---|
| LBN Legal business name | Licea, Erica Berenice |
| Credentials | RDA ORTHO ASSISTANT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 19th, 2019 |
| Last updated | Mar 19th, 2019 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376002287 | NPPES |
| California | MEDICAID | 66604 |
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