Provider Demographics
NPI:1033704242
Name:BAJA, EMERSON
Entity Type:Individual
Prefix:
First Name:EMERSON
Middle Name:
Last Name:BAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 GENTRY ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2100
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:
Practice Address - Street 1:8814 SANTA FE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2821
Practice Address - Country:US
Practice Address - Phone:562-698-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator