Healthcare Provider Details

I. General information

NPI: 1801107669
Provider Name (Legal Business Name): EMILY FISH BRADY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FISH MD, MPH

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 05/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 MEDICAL CENTER RD
MISSION VIEJO CA
92691-6426
US

IV. Provider business mailing address

406 ORCHID AVE UNIT 993
CORONA DEL MAR CA
92625-3444
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1400
  • Fax:
Mailing address:
  • Phone: 608-434-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number150157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: