Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A91852 | CA |
N | 111NI0900X | Internist | A91852 | CA |
N | 208000000X | Pediatrician | A91852 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | 37734 | AZ |
N | 2080P0216X | Pediatric Rheumatologist | A91852 | CA |
NPI | 1619058260 |
---|---|
Provider Name | Dr. Kaleo C Ede |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 12/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A918520 | (05) | CA |
335953 | (05) | AZ |
I64828 | (02) | CA |