Healthcare Provider Details

I. General information

NPI: 1356921555
Provider Name (Legal Business Name): EMILY ANN COYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

2825 FARMERS LN UNIT 308
SANTA ROSA CA
95404-6463
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5016
  • Fax:
Mailing address:
  • Phone: 201-873-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA193486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: