Healthcare Provider Details

I. General information

NPI: 1366532731
Provider Name (Legal Business Name): LINDA VIRA-LELAND EDGAR RN WOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST 08/118
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E. 7TH STREET 08/118
LONG BEACH CA
90822
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5310
  • Fax: 562-826-5662
Mailing address:
  • Phone: 562-826-5310
  • Fax: 562-826-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number256604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: