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NPI Code Detail

MEDICARE: EMERSON SOUSA LPT

MEDICARE: EMERSON SOUSA LPT
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
1167G00000XLicensed Psychiatric Technician40612CA

General Provider Information

NPI Number : 1184187957
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMERSON SOUSA LPT
Provider Business Mailing Address
First Line : 2706 S BAKER AVE
Second Line :
City : ONTARIO
State : CA
Zip : 91761-7222
Country : US
Telephone Number : 909-450-6670
Fax Number :
Provider Business Practice Location Address
First Line : 2900 E DEL MAR BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-4375
Country : US
Telephone Number : 626-795-9901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2019
Last Update Date : 04/09/2019

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Directions to “ EMERSON SOUSA LPT” Practice Location

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