Healthcare Provider Details

I. General information

NPI: 1295879419
Provider Name (Legal Business Name): PEARL EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 26TH AVE
OAKLAND CA
94601-1907
US

IV. Provider business mailing address

1716 JOHN BEVY CT
N LAS VEGAS NV
89086-1385
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-2363
  • Fax: 510-437-2366
Mailing address:
  • Phone: 916-613-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: