Provider Demographics
NPI:1932204054
Name:MCCARTHY, EDRIS JOSEPHINE (RNC, BSN, MBA)
Entity Type:Individual
Prefix:MRS
First Name:EDRIS
Middle Name:JOSEPHINE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RNC, BSN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 LACHMAN LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2233
Mailing Address - Country:US
Mailing Address - Phone:131-045-4604
Mailing Address - Fax:
Practice Address - Street 1:1409 LACHMAN LN
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2233
Practice Address - Country:US
Practice Address - Phone:131-045-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387151163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
R50266436OtherBLUE CROSS BLUE SHIELD