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General NPI Number Information
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NPI Number | 1699197756
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Entity Type | Organization
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Legal Business Name | EDNA MA MD INC
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 14445 OLIVE VIEW DR
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City | SYLMAR
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State | CA
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Zip | 91342-1437
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Country | US
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Telephone | 818-364-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 119 N FAIRFAX AVE # 188
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City | LOS ANGELES
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State | CA
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Zip | 90036-2110
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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 | PRESIDENT
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Name | DR. EDNA MA
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Credential | MD
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Telephone | 310-909-3344
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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 | A89363
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License Number State | CA
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