Healthcare Provider Details

I. General information

NPI: 1295983724
Provider Name (Legal Business Name): EDWARD BUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 E WASHINGTON BLVD
COMMERCE CA
90040-2449
US

IV. Provider business mailing address

527 CROCKER ST
LOS ANGELES CA
90013-2116
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax:
Mailing address:
  • Phone: 213-488-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: