Provider Demographics
NPI:1134980907
Name:ARIAS, EDGARDO D
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:D
Last Name:ARIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3211
Mailing Address - Country:US
Mailing Address - Phone:626-961-8971
Mailing Address - Fax:
Practice Address - Street 1:160 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-3211
Practice Address - Country:US
Practice Address - Phone:626-961-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist