Provider Demographics
NPI:1235215799
Name:NEPOMUCENO, EDWARD MACROHON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MACROHON
Last Name:NEPOMUCENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:411 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3028
Mailing Address - Country:US
Mailing Address - Phone:714-279-5644
Mailing Address - Fax:714-279-4780
Practice Address - Street 1:411 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3028
Practice Address - Country:US
Practice Address - Phone:714-279-5644
Practice Address - Fax:714-279-4780
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI63789Medicare UPIN