MEDICARE: EDGAR DANIEL FIGUEROA CARMONA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1891502654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR DANIEL FIGUEROA CARMONA

Provider Business Mailing Address
First Line	:	1805 N. BUSH ST
Second Line	:	APT #8
City	:	SANTA ANA
State	:	CA
Zip	:	92706
Country	:	US
Telephone Number	:	714-422-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	17822 BEACH BLVD
Second Line	:	STE #278
City	:	HUNINGTON BEACH
State	:	CA
Zip	:	92647
Country	:	US
Telephone Number	:	714-375-3795
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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