Provider Demographics
NPI:1093746299
Name:JAVIER, EMMA CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:CONCEPCION
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMMA
Other - Middle Name:CONCEPCION
Other - Last Name:JAVIER SPINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:75036 GERALD FORD DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2080
Mailing Address - Country:US
Mailing Address - Phone:760-834-2600
Mailing Address - Fax:760-834-2570
Practice Address - Street 1:75036 GERALD FORD DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2080
Practice Address - Country:US
Practice Address - Phone:760-834-2600
Practice Address - Fax:760-834-2570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06712300207RG0300X
CAC53572207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002461Medicaid
NJ0103605000OtherAMERIHEALTH
NJ0002461Medicaid
NJ0103605000OtherAMERIHEALTH