Basic Information
Provider Information
NPI: 1073977120
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLRED
FirstName: ERIKA
MiddleName: TERRY
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3020 CHILDRENS WAY # MC5003
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921234223
CountryCode: US
TelephoneNumber: 8583096300
FaxNumber:  
Practice Location
Address1: 8001 FROST ST
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921232746
CountryCode: US
TelephoneNumber: 8589668052
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/05/2016
LastUpdateDate: 05/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA151669CAN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0210XA151669CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology

No ID Information.


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