=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821820820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMA HELENE O'MALLEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2024
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11815 EDUCATION ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95602-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-888-4550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1009 SYCAMORE LN
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95695-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA65765
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------