Healthcare Provider Details

I. General information

NPI: 1649184425
Provider Name (Legal Business Name): ANTONIO EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUNIOR SEBASTIAN-LUIS EDWARDS

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CENTER COURT DR STE 211
COVINA CA
91724-3668
US

IV. Provider business mailing address

11490 MAGNOLIA AVE APT 321
RIVERSIDE CA
92505-7718
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-4999
  • Fax:
Mailing address:
  • Phone: 442-390-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: