Healthcare Provider Details

I. General information

NPI: 1215846282
Provider Name (Legal Business Name): EMMA GRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 ILLINOIS ST APT 511
SAN DIEGO CA
92104-3995
US

IV. Provider business mailing address

4333 ILLINOIS ST APT 511
SAN DIEGO CA
92104-3995
US

V. Phone/Fax

Practice location:
  • Phone: 339-309-9344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN2367700
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95442961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: