Provider Demographics
NPI:1295163269
Name:EDWARDS, MEKKA A
Entity type:Individual
Prefix:
First Name:MEKKA
Middle Name:A
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 1:23705 VANOWEN ST
Mailing Address - Street 2:179
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3030
Mailing Address - Country:US
Mailing Address - Phone:818-438-6030
Mailing Address - Fax:
Practice Address - Street 1:23705 VANOWEN ST
Practice Address - Street 2:179
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3030
Practice Address - Country:US
Practice Address - Phone:818-438-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist