Healthcare Provider Details

I. General information

NPI: 1184115628
Provider Name (Legal Business Name): CORWIN EDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

12500 BRUCEVILLE RD
ELK GROVE CA
95757-9784
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-7195
  • Fax: 916-875-9709
Mailing address:
  • Phone: 916-874-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA157853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: