Healthcare Provider Details

I. General information

NPI: 1043503345
Provider Name (Legal Business Name): ERICK EMMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 N BROADWAY
ESCONDIDO CA
92026-3043
US

IV. Provider business mailing address

1029 N BROADWAY
ESCONDIDO CA
92026-3043
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: