Provider Demographics
NPI:1518927169
Name:STAPLES EDWARDS, JANET RUTH (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:RUTH
Last Name:STAPLES EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:RUTH
Other - Last Name:STAPLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2205 WEST BEVERLY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-728-0321
Mailing Address - Fax:323-728-1788
Practice Address - Street 1:2205 WEST BEVERLY BOULEVARD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-728-0321
Practice Address - Fax:323-728-1788
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93502Medicare UPIN
CAW14229Medicare ID - Type Unspecified