Healthcare Provider Details

I. General information

NPI: 1710233135
Provider Name (Legal Business Name): EMILIE JOOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5907
  • Fax:
Mailing address:
  • Phone: 626-457-4123
  • Fax: 626-457-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA122155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: