Provider Demographics
NPI:1073990461
Name:GAA, EDWIN BERNARDO
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:BERNARDO
Last Name:GAA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31349 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2814
Mailing Address - Country:US
Mailing Address - Phone:951-383-9663
Mailing Address - Fax:951-365-0059
Practice Address - Street 1:31349 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2814
Practice Address - Country:US
Practice Address - Phone:951-383-9663
Practice Address - Fax:951-365-0059
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)