Provider Demographics
NPI:1770698698
Name:FOLEY, EDITH M (MD)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:M
Last Name:FOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:MARGARET
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 N SAN ANTONIO RD
Mailing Address - Street 2:BLDG 1
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1316
Mailing Address - Country:US
Mailing Address - Phone:805-681-5461
Mailing Address - Fax:
Practice Address - Street 1:301 N R ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5226
Practice Address - Country:US
Practice Address - Phone:805-737-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A704100Medicaid
CAWA70410HMedicare ID - Type Unspecified
H70786Medicare ID - Type Unspecified