Healthcare Provider Details

I. General information

NPI: 1003424771
Provider Name (Legal Business Name): EMETU ONUMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 W JESSICA LN
PHOENIX AZ
85041-4442
US

IV. Provider business mailing address

2745 W JESSICA LN
PHOENIX AZ
85041-4442
US

V. Phone/Fax

Practice location:
  • Phone: 480-200-7688
  • Fax:
Mailing address:
  • Phone: 480-200-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number276789
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN206350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: