Provider Demographics
NPI:1053316794
Name:FRIEDMAN, EDWARD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 4TH AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4426
Mailing Address - Country:US
Mailing Address - Phone:619-425-3840
Mailing Address - Fax:
Practice Address - Street 1:450 4TH AVE
Practice Address - Street 2:STE 214
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4428
Practice Address - Country:US
Practice Address - Phone:619-425-3840
Practice Address - Fax:619-425-3842
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-18
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG323302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G323300Medicaid
CA00G323300Medicaid
CAA45108Medicare UPIN