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General NPI Number Information
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NPI Number | 1285427377
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Entity Type | Individual
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Provider Name | EDWINA THOMAS PEER SUPPORT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 604 W 4TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3216
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Country | US
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Telephone | 909-746-9148
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Fax |
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Provider Business Mailing Address
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Address Line | 85 HORIZON AVE UNIT C
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City | REDLANDS
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State | CA
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Zip | 92374-2345
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Country | US
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Telephone | 909-808-5359
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-YPIKXG
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License Number State | CA
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