Healthcare Provider Details

I. General information

NPI: 1346892833
Provider Name (Legal Business Name): EMMA CISEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WING ST
SAN DIEGO CA
92110-4638
US

IV. Provider business mailing address

PO BOX 17070
SAN DIEGO CA
92177-7070
US

V. Phone/Fax

Practice location:
  • Phone: 619-221-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC18132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: