Provider Demographics
NPI:1437492097
Name:EMERSON, PITTAWAT NARKTAWAN (NP)
Entity Type:Individual
Prefix:MR
First Name:PITTAWAT
Middle Name:NARKTAWAN
Last Name:EMERSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:PITTAWAT
Other - Middle Name:
Other - Last Name:NARKTAWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:275 N EL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-320-4122
Mailing Address - Fax:760-320-2725
Practice Address - Street 1:275 N EL CIELO RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6972
Practice Address - Country:US
Practice Address - Phone:760-320-4122
Practice Address - Fax:760-320-2725
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22214363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22214OtherNP LICENSE #