Provider Demographics
NPI:1073719886
Name:HISHMEH, EMILINA RAQUEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILINA
Middle Name:RAQUEL
Last Name:HISHMEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6806 OASIS BUTTE DR.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7305
Mailing Address - Country:US
Mailing Address - Phone:719-597-4416
Mailing Address - Fax:
Practice Address - Street 1:6806 OASIS BUTTE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7305
Practice Address - Country:US
Practice Address - Phone:719-597-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-20033814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41025741Medicaid