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NPI Code Detail

MEDICARE: PEARL EDWARDS

MEDICARE:   PEARL  EDWARDS
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
1174400000XSpecialist
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1295879419
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEARL EDWARDS
Provider Business Mailing Address
First Line : 1716 JOHN BEVY CT
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89086-1385
Country : US
Telephone Number : 916-613-0262
Fax Number :
Provider Business Practice Location Address
First Line : 2620 26TH AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1907
Country : US
Telephone Number : 510-437-2363
Fax Number : 510-437-2366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 01/26/2024

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Directions to “ PEARL EDWARDS ” Practice Location

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