Provider Demographics
NPI:1871072850
Name:BERROA, ERIKA LISSETTE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:LISSETTE
Last Name:BERROA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 173RD ST APT 602
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7881
Mailing Address - Country:US
Mailing Address - Phone:347-420-7415
Mailing Address - Fax:
Practice Address - Street 1:200 E 173RD ST APT 602
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7881
Practice Address - Country:US
Practice Address - Phone:347-420-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326713164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse