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General NPI Number Information
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NPI Number | 1336564574
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Entity Type | Individual
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Provider Name | BRUCE EDGAR MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 12021 WILSHIRE BLVD # 745
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City | LOS ANGELES
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State | CA
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Zip | 90025-1206
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Country | US
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Telephone | 310-445-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 CAMINITO GIJON
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City | DEL MAR
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State | CA
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Zip | 92014-3938
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Country | US
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Telephone | 858-354-8752
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G44888
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License Number State | CA
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