Provider Demographics
NPI:1013063478
Name:BOST-BAXTER, EMILY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:BOST-BAXTER
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 1:10549 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3513
Mailing Address - Country:US
Mailing Address - Phone:310-405-6902
Mailing Address - Fax:
Practice Address - Street 1:10559 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3526
Practice Address - Country:US
Practice Address - Phone:310-405-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259426-12084P0800X
CAA1057802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry