Provider Demographics
NPI:1376667303
Name:FRITZ, EDWARD JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:FRITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9206
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-9206
Mailing Address - Country:US
Mailing Address - Phone:970-903-8771
Mailing Address - Fax:
Practice Address - Street 1:9685 HAYES ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3660
Practice Address - Country:US
Practice Address - Phone:970-903-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical