Healthcare Provider Details

I. General information

NPI: 1508778234
Provider Name (Legal Business Name): PAUL ANTHONY EDNILAO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 LOS GUILUCOS RD
SANTA ROSA CA
95409
US

IV. Provider business mailing address

479 WHITNEY AVE
VALLEJO CA
94589-3822
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-6344
  • Fax:
Mailing address:
  • Phone: 707-373-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95337689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: