Provider Demographics
NPI:1073640108
Name:STEVEN D. EMMET M.D. INC
Entity Type:Organization
Organization Name:STEVEN D. EMMET M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EMMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-481-8833
Mailing Address - Street 1:773 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2031
Mailing Address - Country:US
Mailing Address - Phone:858-481-8833
Mailing Address - Fax:858-481-0165
Practice Address - Street 1:773 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2031
Practice Address - Country:US
Practice Address - Phone:858-481-8833
Practice Address - Fax:858-481-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17468OtherSTATE LICENSE
CAW9215Medicare ID - Type Unspecified
CAA90497Medicare UPIN