Edgar D Lardizabal
Individual provider Active NPI Registered Nurse · Lathrop, CA
NPI 1154959666 · NPPES record last updated Mar 30, 2020
Key facts
- NPI
- 1154959666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 694768 (CA)
- Practice address
- 1705 Cranbrook CT
Lathrop, CA 95330-8244 - Phone
- (510) 332-2259
- NPI assigned
- Mar 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 694768 | CA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 694768 | CA | Yes |
Addresses
Primary practice location
1705 Cranbrook CT
Lathrop, CA 95330-8244
Mailing address
1705 Cranbrook CT
Lathrop, CA 95330-8244
Phone (510) 332-2259
Other providers in Lathrop, CA
- Parambir Kaur
- Evette Khaew
- Kimberlee Kiep Witthoft
- Beatrice Wamuyu Kihungi
- Megan King
- Lathrop Modern Dentistry, Prof. Corp.
- Lathrop Urgent Care, a Professional Medical Corporation
- Lathrop-Manteca Fire Protection District
- Renetta Marie Lee
- Jennifer Leung
All providers in Lathrop, CA · Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.