=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760670988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD L AUEN PHD M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2007
-----------------------------------------------------
Last Update Date | 11/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 SPANOS CT SUITE 122
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-529-2052
-----------------------------------------------------
Fax | 209-529-0323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 SPANOS CT SUITE 122
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-529-2052
-----------------------------------------------------
Fax | 209-529-0323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. EDWARD LEONARD AUEN
-----------------------------------------------------
Credential | PH.D., M.D.
-----------------------------------------------------
Telephone | 209-529-2052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A50019
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------