Provider Demographics
NPI:1821741083
Name:B. EDENEDO LLC
Entity Type:Organization
Organization Name:B. EDENEDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:UKIRI
Authorized Official - Last Name:EDENEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:424-402-1605
Mailing Address - Street 1:3650 GREENFIELD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7051
Mailing Address - Country:US
Mailing Address - Phone:310-650-0468
Mailing Address - Fax:
Practice Address - Street 1:3650 GREENFIELD AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7051
Practice Address - Country:US
Practice Address - Phone:424-402-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy