Healthcare Provider Details

I. General information

NPI: 1205463684
Provider Name (Legal Business Name): EMILIO JAUREGUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90033-1083
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036176026
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036176026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: