Healthcare Provider Details

I. General information

NPI: 1841957859
Provider Name (Legal Business Name): DR. ASHLEY SARA EMAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 H ST VA CHULA VISTA CLINIC (MENTAL HEALTH SERVICE)
CHULA VISTA CA
91910-5501
US

IV. Provider business mailing address

353 H ST VA CHULA VISTA CLINIC (MENTAL HEALTH SERVICE)
CHULA VISTA CA
91910-5501
US

V. Phone/Fax

Practice location:
  • Phone: 619-861-1176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32963
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number32963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: