=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891046983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD ALPHONSE WAPLES II RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2012
-----------------------------------------------------
Last Update Date | 09/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 IOOF AVE
-----------------------------------------------------
City | GILROY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95020-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-846-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7581 MILLER AVE
-----------------------------------------------------
City | GILROY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95020-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-337-1619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number | 553711
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------