Individual
MS. GINA R ERDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(760) 339-7100
(790) 482-5180
Mailing address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(760) 339-7100
(790) 482-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21561
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA21561
PA LICENSE
CA
Enumeration date
08/05/2011
Last updated
08/05/2011
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