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NPI Code Detail

MEDICARE: EMMA MADELEINE PHAN

MEDICARE: EMMA MADELEINE PHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor19913CA

General Provider Information

NPI Number : 1134977747
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA MADELEINE PHAN
Provider Business Mailing Address
First Line : 612 PIEDMONT
Second Line :
City : IRVINE
State : CA
Zip : 92620-2869
Country : US
Telephone Number : 805-300-7744
Fax Number :
Provider Business Practice Location Address
First Line : 1230 ROSECRANS AVE STE 300
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2494
Country : US
Telephone Number : 213-222-8402
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 05/11/2026

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Directions to “ EMMA MADELEINE PHAN ” Practice Location

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