Healthcare Provider Details

I. General information

NPI: 1639024953
Provider Name (Legal Business Name): EMILY JANE CARVAJAL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

8976 YEW ST
RANCHO CUCAMONGA CA
91730-1253
US

V. Phone/Fax

Practice location:
  • Phone: 818-319-5330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95036672
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9522851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: