Provider Demographics
NPI:1487195640
Name:EDMUNDSON, MORIAH NICOLE MARIE (DO, MS)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:NICOLE MARIE
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:MORIAH
Other - Middle Name:NICOLE MARIE
Other - Last Name:EBERHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MS
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 525
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8029
Mailing Address - Country:US
Mailing Address - Phone:949-364-1040
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 525
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8029
Practice Address - Country:US
Practice Address - Phone:949-364-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16984207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology