Healthcare Provider Details

I. General information

NPI: 1750189650
Provider Name (Legal Business Name): EMMA ECCLES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MAIN ST
WATSONVILLE CA
95076-3761
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-722-1444
  • Fax: 831-722-4414
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: