Provider Demographics
NPI:1114256856
Name:EZEDI, ANTHONY CURTIS
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CURTIS
Last Name:EZEDI
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 1:606 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1147
Mailing Address - Country:US
Mailing Address - Phone:626-331-4686
Mailing Address - Fax:323-294-6942
Practice Address - Street 1:606 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1147
Practice Address - Country:US
Practice Address - Phone:626-331-4686
Practice Address - Fax:323-294-6942
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)