Healthcare Provider Details

I. General information

NPI: 1417279928
Provider Name (Legal Business Name): EMA BAYANI RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 ROYAL ACORN PL
SAN JOSE CA
95120-2756
US

IV. Provider business mailing address

6141 ROYAL ACORN PL
SAN JOSE CA
95120-2756
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-2120
  • Fax:
Mailing address:
  • Phone: 310-714-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP 267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: