Healthcare Provider Details

I. General information

NPI: 1861010100
Provider Name (Legal Business Name): EMANI SECRET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PORTER DR STE 120
SAN RAMON CA
94583-1525
US

IV. Provider business mailing address

1301 LAS JUNTAS WAY APT 118
WALNUT CREEK CA
94597-3630
US

V. Phone/Fax

Practice location:
  • Phone: 925-743-3322
  • Fax:
Mailing address:
  • Phone: 305-975-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: