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General NPI Number Information
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NPI Number | 1376737601
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Entity Type | Individual
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Provider Name | JEFFREY WILLIAM EDMUNDS D.O., M.S., R.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 24909 MADISON AVE UNIT 922
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City | MURRIETA
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State | CA
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Zip | 92562-9731
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Country | US
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Telephone | 562-841-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 24909 MADISON AVE UNIT 922
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City | MURRIETA
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State | CA
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Zip | 92562-9731
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Country | US
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Telephone | 562-841-0023
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 845941
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | CA20A13462
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License Number State | CA
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