Provider Demographics
NPI:1679993505
Name:EDISON, ZANDRA LORRAINE
Entity Type:Individual
Prefix:
First Name:ZANDRA
Middle Name:LORRAINE
Last Name:EDISON
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 1:1412 HELIX ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3908
Mailing Address - Country:US
Mailing Address - Phone:619-302-9252
Mailing Address - Fax:
Practice Address - Street 1:220 EUCLID AVE STE 40
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3617
Practice Address - Country:US
Practice Address - Phone:619-795-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator