MEDICARE: EMMA DOLORES PAINE

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265390736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA DOLORES PAINE

Provider Business Mailing Address
First Line	:	2456 HILGARD AVE APT 603
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1243
Country	:	US
Telephone Number	:	434-987-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 ALLSTON WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2389
Country	:	US
Telephone Number	:	510-883-5230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ EMMA DOLORES PAINE ” Practice Location

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