Healthcare Provider Details

I. General information

NPI: 1508516691
Provider Name (Legal Business Name): EMMA JANE DJABALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

913 SW 6TH AVE UNIT 106
GAINESVILLE FL
32601-1408
US

V. Phone/Fax

Practice location:
  • Phone: 888-689-8273
  • Fax:
Mailing address:
  • Phone: 646-256-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: