Healthcare Provider Details

I. General information

NPI: 1629834072
Provider Name (Legal Business Name): EMILY CONCHITA LLAMAS-NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ZANKER RD STE 203
SAN JOSE CA
95134-2122
US

IV. Provider business mailing address

2880 ZANKER RD STE 203
SAN JOSE CA
95134-2122
US

V. Phone/Fax

Practice location:
  • Phone: 408-752-1401
  • Fax: 888-420-6257
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: