MEDICARE: EMILY JANE CARVAJAL FNP-BC

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	163WC0200X	Critical Care Medicine Registered Nurse	9522851	CA
2	363LP2300X	Primary Care Nurse Practitioner	95036672	CA

General Provider Information

NPI Number	:	1639024953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JANE CARVAJAL FNP-BC

Provider Business Mailing Address
First Line	:	8976 YEW ST
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-1253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 WILSON TER
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4007
Country	:	US
Telephone Number	:	818-319-5330
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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