Healthcare Provider Details

I. General information

NPI: 1790677136
Provider Name (Legal Business Name): EMMA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41111 MISSION BLVD
FREMONT CA
94539-3922
US

IV. Provider business mailing address

140 MAYHEW WAY STE 300
PLEASANT HILL CA
94523-4398
US

V. Phone/Fax

Practice location:
  • Phone: 408-320-5960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberASW131025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: