Provider Demographics
NPI:1730486960
Name:EDWARDS, AUTUMN
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:
Last Name:EDWARDS
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 1:6601 CENTER DR W STE 500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1594
Mailing Address - Country:US
Mailing Address - Phone:323-799-3084
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTER DR W
Practice Address - Street 2:STE. 500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1582
Practice Address - Country:US
Practice Address - Phone:323-799-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002492646-0002-1385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care