Healthcare Provider Details

I. General information

NPI: 1629775705
Provider Name (Legal Business Name): CATHY EDGERTON CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17910 SKY PARK CIR STE 109
IRVINE CA
92614-6418
US

IV. Provider business mailing address

1510 N ROSEWOOD AVE
SANTA ANA CA
92706-3745
US

V. Phone/Fax

Practice location:
  • Phone: 877-721-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: