Healthcare Provider Details

I. General information

NPI: 1619730918
Provider Name (Legal Business Name): EMMA HAINEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 MOONLIGHT LN
LA JOLLA CA
92037-9203
US

IV. Provider business mailing address

5416 MOONLIGHT LN
LA JOLLA CA
92037-7725
US

V. Phone/Fax

Practice location:
  • Phone: 801-889-6869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: