Healthcare Provider Details

I. General information

NPI: 1689905234
Provider Name (Legal Business Name): MR. JOEL WESLEY EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16580 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1386
US

IV. Provider business mailing address

225 CORAL ROSE
IRVINE CA
92603-0103
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-0488
  • Fax:
Mailing address:
  • Phone: 949-379-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: