Provider Demographics
NPI:1265763221
Name:AVERY, EMIKO FRANCES
Entity type:Individual
Prefix:
First Name:EMIKO
Middle Name:FRANCES
Last Name:AVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6873 HAWLEY ST
Mailing Address - Street 2:403
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3391
Mailing Address - Country:US
Mailing Address - Phone:510-875-0364
Mailing Address - Fax:
Practice Address - Street 1:4505 TAFT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3449
Practice Address - Country:US
Practice Address - Phone:510-234-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2015-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker