Healthcare Provider Details

I. General information

NPI: 1235133737
Provider Name (Legal Business Name): EMILY LAMBERT DALTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MIRAIE MD

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HARRIS ST
EUREKA CA
95503-4809
US

IV. Provider business mailing address

670 9TH ST STE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8416
  • Fax: 707-445-4182
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: