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General NPI Number Information
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NPI Number | 1275198004
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Entity Type | Individual
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Provider Name | EDGAR MURADYAN
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Gender | Male
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-721-0803
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Fax |
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Provider Business Mailing Address
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Address Line | 8377 GABRIEL DR APT A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3283
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Country | US
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Telephone | 909-721-0803
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95001126
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License Number State | CA
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