Individual
DR. ERICK ALFONSO MAFONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
319 F ST, STE 102, CHULA VISTA, CA 91910-2666
(619) 476-1200
(619) 420-7849
Mailing address
319 F ST, STE 102, CHULA VISTA, CA 91910-2666
(619) 476-1200
(619) 420-7849
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
A78399
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A783990
—
CA
Enumeration date
06/09/2005
Last updated
07/08/2007
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