Provider Demographics
NPI:1386375111
Name:BELMONT, EMILY ANN GRAY (AC/PC-PNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN GRAY
Last Name:BELMONT
Suffix:
Gender:F
Credentials:AC/PC-PNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3216 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1898
Mailing Address - Country:US
Mailing Address - Phone:714-609-9053
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:714-609-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95021703363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program