Healthcare Provider Details

I. General information

NPI: 1124580741
Provider Name (Legal Business Name): REZA JOHN EMAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S AKERS ST
VISALIA CA
93277-8311
US

IV. Provider business mailing address

1100 S AKERS ST
VISALIA CA
93277-8311
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-3300
  • Fax:
Mailing address:
  • Phone: 559-624-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA180452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: