Healthcare Provider Details

I. General information

NPI: 1134818909
Provider Name (Legal Business Name): DARIA EMELIANOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE STE 207
DOWNEY CA
90241-5004
US

IV. Provider business mailing address

220 THE VILLAGE APPT 304
REDONDO BEACH CA
90277
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-4411
  • Fax:
Mailing address:
  • Phone: 802-383-8528
  • 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: