Provider Demographics
NPI:1871995159
Name:WILLS, ERICA JAQUAI
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:JAQUAI
Last Name:WILLS
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 1:100 W BROADWAY STE 5005
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-9445
Mailing Address - Country:US
Mailing Address - Phone:562-332-4471
Mailing Address - Fax:562-285-0330
Practice Address - Street 1:100 W BROADWAY STE 5005
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-9445
Practice Address - Country:US
Practice Address - Phone:562-332-4471
Practice Address - Fax:562-285-0330
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator