Provider Demographics
NPI:1073511150
Name:RICE, EMMETT LEE (DO)
Entity Type:Individual
Prefix:
First Name:EMMETT
Middle Name:LEE
Last Name:RICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 HISTORIC DECATUR RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6127
Mailing Address - Country:US
Mailing Address - Phone:619-398-2960
Mailing Address - Fax:619-391-0017
Practice Address - Street 1:2448 HISTORIC DECATUR RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106
Practice Address - Country:US
Practice Address - Phone:619-398-2960
Practice Address - Fax:619-398-2970
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93554Medicare UPIN