Provider Demographics
NPI:1659917136
Name:HYDE, EDNA ANN
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:ANN
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 WINCHESTER CREEK AVE APT 5204
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4108
Mailing Address - Country:US
Mailing Address - Phone:818-620-8035
Mailing Address - Fax:
Practice Address - Street 1:37755 GOLDEN EAGLE AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7907
Practice Address - Country:US
Practice Address - Phone:760-994-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC5931335OtherDRIVER LICENSE