Provider Demographics
NPI:1083422158
Name:JEDDI, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:JEDDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 FULLERTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3100
Mailing Address - Country:US
Mailing Address - Phone:951-371-9500
Mailing Address - Fax:951-371-9194
Practice Address - Street 1:1820 FULLERTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3100
Practice Address - Country:US
Practice Address - Phone:951-371-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily