Individual
ERASMO SAN JUAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
360 WHISKEY HILL RD, LA SELVA BEACH, CA 95076-8521
(831) 724-9333
Mailing address
3306 DEL MONTE BLVD APT 2, MARINA, CA 93933-2429
(831) 359-9452
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D2471603
DRIVER LICENSE
CA
Enumeration date
05/10/2007
Last updated
07/08/2007
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