Edna Karina Favela, R.D., CDE
Individual provider Active NPI Health Educator · Grand Terrace, CA
NPI 1871965665 · NPPES record last updated Oct 20, 2015
Key facts
- NPI
- 1871965665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Educator 174H00000X
- License
- 1000367 (CA)
- Practice address
- 12168 Mount Vernon Ave Unit 80
Grand Terrace, CA 92313-5545 - Phone
- (909) 638-3272
- NPI assigned
- Oct 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1000367 | CA | MD | Health Educator |
| 21420614 | CA | MD | Health Educator |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 1000367 | CA | Yes |
| Health Educator | 174H00000X | 21420614 | CA |
Addresses
Primary practice location
12168 Mount Vernon Ave Unit 80
Grand Terrace, CA 92313-5545
Mailing address
12168 Mount Vernon Ave Unit 80
Grand Terrace, CA 92313-5545
Phone (909) 638-3272
Other providers in Grand Terrace, CA
- Trisha N Engel
- Equanimity Hospice & Palliative Care, Inc.
- Eric Eschweiler
- Marisol Espinoza Garcia
- Philip Thomas Farabaugh
- Ramon U. Ferra
- Fit Forever Physical Therapy, Inc.
- Five Oaks Speech Therapy Services PC
- Ashley Fonseca-Tweed
- Ryan Forgette
All providers in Grand Terrace, CA · Health Educator in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2015. 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.