Healthcare Provider Details

I. General information

NPI: 1205362258
Provider Name (Legal Business Name): WESLEIGH FOWLER EDWARDS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4044 FIFTH AVE
SAN DIEGO CA
92103-2106
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 619-849-4469
  • Fax: 619-849-1547
Mailing address:
  • Phone: 858-554-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA160951
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA160951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: