Provider Demographics
NPI:1366690018
Name:EMEMBOLU, FEYI NNEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:FEYI
Middle Name:NNEKA
Last Name:EMEMBOLU
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:PO BOX 40050
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-4050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4483
Practice Address - Country:US
Practice Address - Phone:661-382-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111176207P00000X
IL125.052904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADI4882Medicare PIN