Healthcare Provider Details

I. General information

NPI: 1083422158
Provider Name (Legal Business Name): EMMA JEDDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 FULLERTON AVE STE 120
CORONA CA
92881-3100
US

IV. Provider business mailing address

1820 FULLERTON AVE STE 120
CORONA CA
92881-3100
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-9500
  • Fax:
Mailing address:
  • Phone: 951-371-9500
  • Fax: 951-371-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: