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General NPI Number Information
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NPI Number | 1174015192
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Entity Type | Individual
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Provider Name | EDWIN ENWIA PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 1000 BRISTOL ST N STE 1B
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-752-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 9139 OAK ST
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City | BELLFLOWER
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State | CA
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Zip | 90706-4403
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Country | US
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Telephone | 562-900-9345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA55642
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License Number State | CA
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