Provider Demographics
NPI:1134466634
Name:EDWARDS, DEVIN WAYNE
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:WAYNE
Last Name:EDWARDS
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 1:5688 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2916
Mailing Address - Country:US
Mailing Address - Phone:909-534-9814
Mailing Address - Fax:
Practice Address - Street 1:5688 ELM AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2916
Practice Address - Country:US
Practice Address - Phone:909-534-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker