Provider Demographics
NPI:1265157382
Name:EMETU, ROBERTA (PHD, MPH, MLS)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:EMETU
Suffix:
Gender:F
Credentials:PHD, MPH, MLS
Other - Prefix:DR
Other - First Name:BOBBIE
Other - Middle Name:
Other - Last Name:EMETU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, MPH, MLS
Mailing Address - Street 1:1625 SCHRADER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6213
Mailing Address - Country:US
Mailing Address - Phone:323-860-5842
Mailing Address - Fax:
Practice Address - Street 1:1625 SCHRADER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6213
Practice Address - Country:US
Practice Address - Phone:323-860-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
01536011OtherMEDICAL