Provider Demographics
NPI:1942491634
Name:REKUC, EMILY KATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:REKUC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6702
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6702
Mailing Address - Country:US
Mailing Address - Phone:760-777-4067
Mailing Address - Fax:760-777-4096
Practice Address - Street 1:79440 HIGHWAY 111 STE 105
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4500
Practice Address - Country:US
Practice Address - Phone:760-777-4067
Practice Address - Fax:760-777-4096
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012235207V00000X
CA20A11655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI996YMedicare PIN