Provider Demographics
NPI:1215185640
Name:EDINGER MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EDINGER MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:ANGUIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-965-2535
Mailing Address - Street 1:PO BOX 8039
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8039
Mailing Address - Country:US
Mailing Address - Phone:714-965-2535
Mailing Address - Fax:714-965-2581
Practice Address - Street 1:18682 BEACH BLVD STE 145-155
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2048
Practice Address - Country:US
Practice Address - Phone:714-965-2500
Practice Address - Fax:714-965-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1466AMedicare PIN