Provider Demographics
NPI:1417992561
Name:FALCON, EDGARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:A
Last Name:FALCON
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:PO BOX 5582
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-5582
Mailing Address - Country:US
Mailing Address - Phone:805-278-7888
Mailing Address - Fax:805-484-2497
Practice Address - Street 1:115 VIENTOS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1602
Practice Address - Country:US
Practice Address - Phone:805-278-7888
Practice Address - Fax:805-484-2497
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31579207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC03898Medicare UPIN
CAA31579Medicare ID - Type Unspecified