Healthcare Provider Details

I. General information

NPI: 1376737601
Provider Name (Legal Business Name): JEFFREY WILLIAM EDMUNDS D.O., M.S., R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24909 MADISON AVE UNIT 922
MURRIETA CA
92562-9731
US

IV. Provider business mailing address

24909 MADISON AVE UNIT 922
MURRIETA CA
92562-9731
US

V. Phone/Fax

Practice location:
  • Phone: 562-841-0023
  • Fax:
Mailing address:
  • Phone: 562-841-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number845941
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCA20A13462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: