Provider Demographics
NPI:1437876018
Name:EDWARDS, KENYA (CPT1)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CPT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3554
Mailing Address - Country:US
Mailing Address - Phone:800-248-3571
Mailing Address - Fax:
Practice Address - Street 1:402 W BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3554
Practice Address - Country:US
Practice Address - Phone:800-248-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy