Healthcare Provider Details

I. General information

NPI: 1427905868
Provider Name (Legal Business Name): EMILY MARIE REALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 W ADAMS BLVD STE 200
LOS ANGELES CA
90018-2236
US

IV. Provider business mailing address

125 ESPERANZA AVE APT 14
SIERRA MADRE CA
91024-2444
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-9372
  • Fax:
Mailing address:
  • Phone: 818-939-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: