MEDICARE: MRS. KRYSTEL TERISE EDMONDS-BIGLOW PSY D

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	103TC0700X	Clinical Psychologist	PSY19260	CA

General Provider Information

NPI Number	:	1659582534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTEL TERISE EDMONDS-BIGLOW PSY D

Provider Business Mailing Address
First Line	:	5757 W CENTURY BLVD STE 700
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-6409
Country	:	US
Telephone Number	:	323-369-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 W CENTURY BLVD STE 700
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-6409
Country	:	US
Telephone Number	:	323-369-1292
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	02/10/2010

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