Healthcare Provider Details

I. General information

NPI: 1255065785
Provider Name (Legal Business Name): EMMA CRISTINA STAPLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LOMITA BLVD STE 100
TORRANCE CA
90505-5100
US

IV. Provider business mailing address

5850 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-0508
  • Fax: 310-325-8109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: