Healthcare Provider Details

I. General information

NPI: 1659595478
Provider Name (Legal Business Name): JUANITA EDWARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21216 NORTHWEST FWY STE 280
CYPRESS TX
77429-0017
US

IV. Provider business mailing address

P.O. BOX 106 DEPT #701
HOUSTON TX
77001-0106
US

V. Phone/Fax

Practice location:
  • Phone: 281-517-0060
  • Fax: 281-475-2045
Mailing address:
  • Phone: 281-517-0060
  • Fax: 281-475-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM7161
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM7161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: