MEDICARE: DR. TINA FORTHUN EDWARDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A93271	CA

General Provider Information

NPI Number	:	1932173713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA FORTHUN EDWARDS MD

Provider Business Mailing Address
First Line	:	2125 S EL CAMINO REAL STE 200
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-425-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 S EL CAMINO REAL STE 200
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-425-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	01/07/2025

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