Provider Demographics
NPI:1972635498
Name:EDWARDS, KATHERINE CLAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CLAIRE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 MOUND AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3122
Mailing Address - Country:US
Mailing Address - Phone:310-985-3941
Mailing Address - Fax:
Practice Address - Street 1:3291 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3099
Practice Address - Country:US
Practice Address - Phone:805-677-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87624207V00000X
AK4806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKM00294Medicaid
AKK161771Medicare PIN
AK0361450001Medicare NSC
AKM00294Medicaid