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General NPI Number Information
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NPI Number | 1184329922
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Entity Type | Individual
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Provider Name | TIARA EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 5830 E 2ND ST STE 8
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City | CASPER
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State | WY
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Zip | 82609-4308
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Country | US
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Telephone | 818-724-9517
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Fax |
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Provider Business Mailing Address
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Address Line | 7800 TOPANGA CANYON BLVD APT 101
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City | CANOGA PARK
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State | CA
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Zip | 91304-5554
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Country | US
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Telephone | 323-404-5212
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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