Provider Demographics
NPI:1679944433
Name:MCDUFFIE EDMOND, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MCDUFFIE EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MCDUFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7323 1/2 RICHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3311
Mailing Address - Country:US
Mailing Address - Phone:347-903-0450
Mailing Address - Fax:310-436-9331
Practice Address - Street 1:649 E ALBERTONI ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1538
Practice Address - Country:US
Practice Address - Phone:310-436-9300
Practice Address - Fax:310-436-9331
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program