Provider Demographics
NPI:1336856798
Name:GADIA, EDWARD (RCFE ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GADIA
Suffix:
Gender:M
Credentials:RCFE ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 AMERICANO WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7212
Mailing Address - Country:US
Mailing Address - Phone:707-344-4744
Mailing Address - Fax:707-759-4136
Practice Address - Street 1:524 AMERICANO WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7212
Practice Address - Country:US
Practice Address - Phone:707-344-4744
Practice Address - Fax:707-759-4136
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN185528164X00000X
CA376G00000X
CARCFE376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No164X00000XNursing Service ProvidersLicensed Vocational Nurse