=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083564082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL EDNIE MD XRH OF CA PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 N BRAND BLVD STE 700
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-990-6111
-----------------------------------------------------
Fax | 857-576-0059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 1ST AVE STE 103
-----------------------------------------------------
City | NEEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02494-2759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-990-6111
-----------------------------------------------------
Fax | 857-576-0059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP GENERAL MANAGER
-----------------------------------------------------
Name | ASHLEY ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-687-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------