Healthcare Provider Details

I. General information

NPI: 1508395872
Provider Name (Legal Business Name): EMILY A COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CALLE AMANECER
SAN CLEMENTE CA
92673-6250
US

IV. Provider business mailing address

19401 S VERMONT AVE STE A200
TORRANCE CA
90502-4418
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5100
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax: 310-436-8285

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 Code225X00000X
TaxonomyOccupational Therapist
License Number18433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: