Healthcare Provider Details

I. General information

NPI: 1831009026
Provider Name (Legal Business Name): DR. JENNIFER EMMETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE UNIT 1707
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

388 E OCEAN BLVD UNIT 1707
LONG BEACH CA
90802-5279
US

V. Phone/Fax

Practice location:
  • Phone: 800-854-7771
  • Fax:
Mailing address:
  • Phone: 516-578-9859
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: