Provider Demographics
NPI:1275517302
Name:JARDINI, EDWARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PAUL
Last Name:JARDINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 LAS TABLAS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9711
Mailing Address - Country:US
Mailing Address - Phone:805-434-0025
Mailing Address - Fax:805-434-0029
Practice Address - Street 1:1320 LAS TABLAS RD
Practice Address - Street 2:SUITE F
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-0025
Practice Address - Fax:805-434-0029
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G601660OtherBLUE SHIELD PIN
CA115OtherCMSP PIN
A53559Medicare UPIN
CA115OtherCMSP PIN
G60166Medicare PIN