MEDICARE: ELIZABETH DALE EDWARDS M.S. CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AU858	CA
2	237600000X	Audiologist-Hearing Aid Fitter	HA1841	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AU0008581	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1245356427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DALE EDWARDS M.S. CCC-A

Provider Business Mailing Address
First Line	:	3478 GAVIOTA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4920
Country	:	US
Telephone Number	:	562-208-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	4926 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6102
Country	:	US
Telephone Number	:	310-660-6034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	09/11/2025

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