Provider Demographics
NPI:1730194127
Name:EBERT, EMILY ANN (MD, MPH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:EBERT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5157
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92412-5157
Mailing Address - Country:US
Mailing Address - Phone:909-580-6240
Mailing Address - Fax:909-580-6308
Practice Address - Street 1:ARROWHEAD REGIONAL MEDICAL CENTER
Practice Address - Street 2:400 N. PEPPER AVE
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-6240
Practice Address - Fax:909-580-6308
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A450220Medicaid
CA00A450220Medicaid
B87683Medicare UPIN