Provider Demographics
NPI:1144392416
Name:EMQ
Entity Type:Organization
Organization Name:EMQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-379-9085
Mailing Address - Street 1:4389 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4743
Mailing Address - Country:US
Mailing Address - Phone:408-723-1032
Mailing Address - Fax:
Practice Address - Street 1:251 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1940
Practice Address - Country:US
Practice Address - Phone:408-379-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36007322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children