MEDICARE: PAOLA 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
1	104100000X	Social Worker	16396	AZ

General Provider Information

NPI Number	:	1386183200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA EDWARDS

Provider Business Mailing Address
First Line	:	10617 W ODEUM LN
Second Line	:
City	:	TOLLESON
State	:	AZ
Zip	:	85353-7671
Country	:	US
Telephone Number	:	469-222-0069
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 W THOMAS RD STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-4830
Country	:	US
Telephone Number	:	480-589-1651
Fax Number	:

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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Directions to “ PAOLA EDWARDS ” Practice Location

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