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General NPI Number Information
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NPI Number | 1043458268
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Entity Type | Organization
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Legal Business Name | EDGAR ARDILA MD INC.
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 11705 SLATE AVE SUITE 200
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City | RIVERSIDE
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State | CA
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Zip | 92505-5196
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Country | US
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Telephone | 951-351-1344
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Fax | 951-359-3748
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Provider Business Mailing Address
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Address Line | 28030 BLACKBERRY WAY
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City | YORBA LINDA
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State | CA
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Zip | 92887
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Country | US
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Telephone | 951-351-1346
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Fax | 951-351-1346
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Authorized Official
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Title or Position | PHYSICIAN
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Name | EDGAR ARDILA
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Credential | MD
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Telephone | 951-534-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A54539
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License Number State | CA
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