Provider Demographics
NPI:1619007861
Name:EDMOND, DAVID A II
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:EDMOND
Suffix:II
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 1:4667 N BANNER DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-1734
Mailing Address - Country:US
Mailing Address - Phone:310-508-1266
Mailing Address - Fax:
Practice Address - Street 1:8220 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3030
Practice Address - Country:US
Practice Address - Phone:323-570-0445
Practice Address - Fax:323-778-0485
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator