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Individual
DR. SHASTA ERICSON
Active
Individual
DR. SHASTA ERICSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC., D.A.O.M.
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC5149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77041-5394
TAX ID
—
Enumeration date
12/12/2006
Last updated
04/03/2019
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