Provider Demographics
NPI:1104279611
Name:CHUE, EMMANUEL DAVID LANDA
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:DAVID LANDA
Last Name:CHUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EMMANUEL
Other - Middle Name:
Other - Last Name:LANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11465 QUEENSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5167
Mailing Address - Country:US
Mailing Address - Phone:707-339-1362
Mailing Address - Fax:
Practice Address - Street 1:3075 MYERS ST.
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-955-7263
Practice Address - Fax:951-955-7205
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health