Healthcare Provider Details

I. General information

NPI: 1689240152
Provider Name (Legal Business Name): EMMA EILEEN ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 POUNDS AVE
WHITTIER CA
90603-3024
US

IV. Provider business mailing address

10818 POUNDS AVE
WHITTIER CA
90603-3024
US

V. Phone/Fax

Practice location:
  • Phone: 714-742-0774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7601
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: