Provider Demographics
NPI:1568787026
Name:WALL, EMMA (BMBCH)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:BMBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 UCLA MEDICAL PLZ
Mailing Address - Street 2:ROOM 1524 - DIVISION OF CHILD PSYCHIATRY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6968
Mailing Address - Country:US
Mailing Address - Phone:310-825-7733
Mailing Address - Fax:
Practice Address - Street 1:300 UCLA MEDICAL PLZ
Practice Address - Street 2:ROOM 1524 - DIVISION OF CHILD PSYCHIATRY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6968
Practice Address - Country:US
Practice Address - Phone:310-825-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1371092084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry