Provider Demographics
NPI:1750470803
Name:KASIDI, EDDAH (LVN)
Entity type:Individual
Prefix:
First Name:EDDAH
Middle Name:
Last Name:KASIDI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 TORI DR.
Mailing Address - Street 2:
Mailing Address - City:1230
Mailing Address - State:CA
Mailing Address - Zip Code:92545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 TORI DR.
Practice Address - Street 2:
Practice Address - City:HEME T
Practice Address - State:CA
Practice Address - Zip Code:92545-1230
Practice Address - Country:US
Practice Address - Phone:951-445-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA166988164X00000X
CAVN166988164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse