Provider Demographics
NPI:1093835696
Name:FLETCHER, EDWARD WAYNE
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WAYNE
Last Name:FLETCHER
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 1:1445 W FLORIDA AVE
Mailing Address - Street 2:SPACE 96
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3864
Mailing Address - Country:US
Mailing Address - Phone:951-766-5334
Mailing Address - Fax:
Practice Address - Street 1:6355 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3163
Practice Address - Country:US
Practice Address - Phone:951-369-0219
Practice Address - Fax:951-686-1029
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator