Provider Demographics
NPI:1700570637
Name:PRESTON, EMMA MICHELLE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MICHELLE
Last Name:PRESTON
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 1:14595 BRONSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3554
Mailing Address - Country:US
Mailing Address - Phone:408-515-2849
Mailing Address - Fax:
Practice Address - Street 1:5080 N FRUIT AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3062
Practice Address - Country:US
Practice Address - Phone:559-493-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program