Healthcare Provider Details

I. General information

NPI: 1578849287
Provider Name (Legal Business Name): EMILY BETH FINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 E GUASTI RD STE 700
ONTARIO CA
91761-7643
US

IV. Provider business mailing address

PO BOX 1273
CLAREMONT CA
91711-1273
US

V. Phone/Fax

Practice location:
  • Phone: 909-480-8235
  • Fax: 909-354-3363
Mailing address:
  • Phone: 909-480-8235
  • Fax: 909-354-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23742
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 23742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: