Healthcare Provider Details

I. General information

NPI: 1588906390
Provider Name (Legal Business Name): CONSUELO MERCE' EDWARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 FAREN DR
SANTA ANA CA
92705-2451
US

IV. Provider business mailing address

1391 FAREN DR
SANTA ANA CA
92705-2451
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-3918
  • Fax: 714-838-4737
Mailing address:
  • Phone: 714-838-3918
  • Fax: 714-838-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCFE38754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberCFE38754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: