Provider Demographics
NPI:1588810329
Name:CLADERA, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CLADERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 MARRON RD
Mailing Address - Street 2:# 302
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-8386
Mailing Address - Country:US
Mailing Address - Phone:865-712-8398
Mailing Address - Fax:
Practice Address - Street 1:8765 AERO DR
Practice Address - Street 2:130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1781
Practice Address - Country:US
Practice Address - Phone:858-541-0181
Practice Address - Fax:858-430-0919
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine