Healthcare Provider Details

I. General information

NPI: 1295045003
Provider Name (Legal Business Name): EMMANUEL SMITH RABANO B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WISCONSIN AVE UNIT 202
LONG BEACH CA
90814-6736
US

IV. Provider business mailing address

370 WISCONSIN AVE. #202
LONG BEACH CA
90814
US

V. Phone/Fax

Practice location:
  • Phone: 714-458-4287
  • Fax:
Mailing address:
  • Phone: 714-458-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: