Individual
ERIC TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
18800 MAIN ST, SUITE 104, HUNTINGTON BEACH, CA 92648-1707
(714) 841-1963
(714) 841-6919
Mailing address
18800 MAIN ST, SUITE 104, HUNTINGTON BEACH, CA 92648-1707
(714) 841-1963
(714) 841-6919
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E4459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E44590
B/S OF CAL-INDIVIDUAL ID
CA
01
—
73-1649799
BILLING TAX ID
CA
Enumeration date
09/22/2006
Last updated
07/09/2007
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