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General NPI Number Information
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NPI Number | 1457322380
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Entity Type | Individual
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Provider Name | EDWARD A MCCLUSKEY MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-4475
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Fax | 909-558-0187
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Provider Business Mailing Address
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Address Line | FILE NUMBER 54701
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City | LOS ANGELES
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State | CA
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Zip | 90074-4701
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G70496
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | G70496
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License Number State | CA
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