Healthcare Provider Details

I. General information

NPI: 1700570637
Provider Name (Legal Business Name): EMMA MICHELLE PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N FRUIT AVE STE 102
FRESNO CA
93711-3062
US

IV. Provider business mailing address

14595 BRONSON AVE
SAN JOSE CA
95124-3554
US

V. Phone/Fax

Practice location:
  • Phone: 559-493-5609
  • Fax:
Mailing address:
  • Phone: 408-515-2849
  • 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: