Active NPI
Edmond G. O'Donnell, MFT
- Marriage & Family Therapist
- Rancho Cucamonga, CA
National Provider Identifier
1366560351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 7839
- Practice address
- 9631 Business Center Dr
Building 14, Suite E
Rancho Cucamonga, CA 91730-4545 - Phone
- (909) 945-8894
- Fax
- (909) 945-2855
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 7839 | CA | Primary |
Addresses
Primary practice location
9631 Business Center Dr
Building 14, Suite E
Rancho Cucamonga, CA 91730-4545
Mailing address
2110 N. San Antonio Ave.
P. O. Box 608
Upland, CA 91784
Phone (909) 985-2803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7839 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366560351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 N. SAN ANTONIO AVE.",
"address_2": "P. O. BOX 608",
"city": "UPLAND",
"state": "CA",
"postal_code": "91784",
"telephone_number": "909-985-2803",
"fax_number": "909-982-8643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9631 BUSINESS CENTER DR",
"address_2": "BUILDING 14, SUITE E",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917304545",
"telephone_number": "909-945-8894",
"fax_number": "909-945-2855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DONNELL",
"first_name": "EDMOND",
"middle_name": "G.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "7839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.