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General NPI Number Information
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NPI Number | 1871030569
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Entity Type | Individual
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Provider Name | VIRGINIA EDITH EDWARDS BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 12501 IMPERIAL HWY STE 230
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City | NORWALK
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State | CA
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Zip | 90650-1430
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Country | US
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Telephone | 626-344-4274
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W MENDOCINO ST
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City | ALTADENA
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State | CA
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Zip | 91001-4526
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Country | US
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Telephone | 626-344-4274
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-53664
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License Number State | CA
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