Active NPI
Ericka L Henderson
- Driver
- Fontana, CA
National Provider Identifier
1184473555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- B3639978
- Practice address
- 15073 Primrose CT
Fontana, CA 92336-1634 - Phone
- (909) 776-6775
- NPI assigned
- May 16, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | B3639978 | CA | Primary |
Addresses
Primary practice location
15073 Primrose CT
Fontana, CA 92336-1634
Mailing address
15073 Primrose CT
Fontana, CA 92336-1634
Phone (909) 776-6775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B3639978 | CA | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715817600000",
"number": "1184473555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15073 PRIMROSE CT",
"city": "FONTANA",
"state": "CA",
"postal_code": "923361634",
"telephone_number": "909-776-6775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15073 PRIMROSE CT",
"city": "FONTANA",
"state": "CA",
"postal_code": "923361634",
"telephone_number": "909-776-6775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "ERICKA",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-16",
"last_updated": "2024-05-16",
"certification_date": "2024-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "CA",
"license": "B3639978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.