Healthcare Provider Details

I. General information

NPI: 1265390736
Provider Name (Legal Business Name): EMMA DOLORES PAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 ALLSTON WAY
BERKELEY CA
94710-2389
US

IV. Provider business mailing address

2456 HILGARD AVE APT 603
BERKELEY CA
94709-1243
US

V. Phone/Fax

Practice location:
  • Phone: 510-883-5230
  • Fax:
Mailing address:
  • Phone: 434-987-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: