Healthcare Provider Details

I. General information

NPI: 1003423146
Provider Name (Legal Business Name): EMILY DEE VI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 N 4TH ST
SAN JOSE CA
95112-4713
US

IV. Provider business mailing address

432 S 21ST ST
SAN JOSE CA
95116-3106
US

V. Phone/Fax

Practice location:
  • Phone: 800-906-0862
  • Fax:
Mailing address:
  • Phone: 714-614-5337
  • 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 StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: