Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 299264 | CA |
Y | 213ES0000X | Sports Medicine | 299264 | CA |
NPI | 1477150886 |
---|---|
Provider Name | Robin Edwards |
First Address | San Leandro, CA 94579-1714 |
Second Address | Oakland, CA 94607-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2020 |
Last Update Date | 08/10/2020 |