Provider Demographics
NPI:1174666754
Name:GUNNOE, EDWARD (BA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:GUNNOE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:GUNNOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 12175
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2175
Mailing Address - Country:US
Mailing Address - Phone:909-380-4646
Mailing Address - Fax:909-798-9207
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9234
Practice Address - Fax:909-421-9411
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker