Healthcare Provider Details

I. General information

NPI: 1265351241
Provider Name (Legal Business Name): EMILY ITATANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N CENTRAL AVE STE 6
CAMPBELL CA
95008-1428
US

IV. Provider business mailing address

986 WESTMONT CT
SAN JOSE CA
95117-2568
US

V. Phone/Fax

Practice location:
  • Phone: 760-203-1078
  • Fax:
Mailing address:
  • Phone: 408-799-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: