Provider Demographics
NPI:1356752554
Name:JEFFREY, EMMANUEL III (OD, DRPH, MPH)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:JEFFREY
Suffix:III
Gender:M
Credentials:OD, DRPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25024 PROSPECT AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25024 PROSPECT AVE
Practice Address - Street 2:APT. C
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2916
Practice Address - Country:US
Practice Address - Phone:747-888-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital