Healthcare Provider Details

I. General information

NPI: 1023759925
Provider Name (Legal Business Name): EMILY LILIAN EDWARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 10TH ST STE 304
SANTA MONICA CA
90401-2831
US

IV. Provider business mailing address

1450 10TH ST STE 304
SANTA MONICA CA
90401-2831
US

V. Phone/Fax

Practice location:
  • Phone: 310-458-1714
  • Fax:
Mailing address:
  • Phone: 310-458-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA188000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: