Healthcare Provider Details

I. General information

NPI: 1871498923
Provider Name (Legal Business Name): EMMA MYERS PLACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CUSHING RD
SAN DIEGO CA
92106-6189
US

IV. Provider business mailing address

3033 CARLETON ST APT B
SAN DIEGO CA
92106-2618
US

V. Phone/Fax

Practice location:
  • Phone: 619-564-6700
  • Fax:
Mailing address:
  • Phone: 760-920-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT29354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: