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General NPI Number Information
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NPI Number | 1093438384
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Entity Type | Organization
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Legal Business Name | EDWARDS MALIBU
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 23410 CIVIC CENTER WAY STE E7
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City | MALIBU
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State | CA
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Zip | 90265-5917
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Country | US
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Telephone | 970-693-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 23410 CIVIC CENTER WAY STE E7
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City | MALIBU
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State | CA
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Zip | 90265-5917
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Country | US
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Telephone | 970-693-0015
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE ADMINISTRATOR
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Name | ASHLEY BLAIR ELDER
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Credential |
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Telephone | 737-247-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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