Healthcare Provider Details

I. General information

NPI: 1861062754
Provider Name (Legal Business Name): EMMA KARINA MICHEL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. EMMA KARINA GONZALEZ

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

25764 CAYENNE CT
MORENO VALLEY CA
92553-4884
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4850
  • Fax:
Mailing address:
  • Phone: 951-907-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT126004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: