Healthcare Provider Details

I. General information

NPI: 1669988184
Provider Name (Legal Business Name): EMMA NATSUMI CONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 HAYDEN ST
HONOLULU HI
96815-4378
US

IV. Provider business mailing address

3701 OVERLAND AVE APT 134
LOS ANGELES CA
90034-6347
US

V. Phone/Fax

Practice location:
  • Phone: 949-929-5034
  • Fax:
Mailing address:
  • Phone: 949-929-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: