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General NPI Number Information
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NPI Number | 1174661540
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Entity Type | Individual
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Provider Name | EDWARD GARDNER RN
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 IOWA AVE SUITE 230
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City | RIVERSIDE
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State | CA
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Zip | 92507-2420
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Country | US
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Telephone | 951-369-8604
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Fax | 951-715-4594
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Provider Business Mailing Address
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Address Line | 4426 UNIVERSITY AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-3146
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Country | US
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Telephone | 951-788-8131
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 280999
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License Number State | CA
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