Healthcare Provider Details

I. General information

NPI: 1811902612
Provider Name (Legal Business Name): LELA M EMAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVENUE SUITE 202
SANTA ROSA CA
95405
US

IV. Provider business mailing address

1111 SONOMA AVENUE SUITE 202
SANTA ROSA CA
95405
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1626
  • Fax: 707-575-3941
Mailing address:
  • Phone: 707-575-1626
  • Fax: 707-575-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG61698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: