Provider Demographics
NPI:1710917513
Name:ASTON, EDWARD E IV (M D)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:ASTON
Suffix:IV
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3420
Mailing Address - Country:US
Mailing Address - Phone:714-879-4312
Mailing Address - Fax:714-879-2154
Practice Address - Street 1:333 W BASTANCHURY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3420
Practice Address - Country:US
Practice Address - Phone:714-879-4312
Practice Address - Fax:714-879-2154
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19019207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G190190Medicaid
CAG19019Medicare ID - Type Unspecified
CA00G190190Medicaid