Healthcare Provider Details

I. General information

NPI: 1740045293
Provider Name (Legal Business Name): EMMA LONGO MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1520 SAN PABLO ST STE 4300
LOS ANGELES CA
90033-5330
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1000
  • Fax:
Mailing address:
  • Phone: 323-442-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPTL20473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: