DR. KEITH JOHN EDWARDS (NPI# 1164636056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164636056 |
| Entity Type | Individual |
| Full Name | DR. KEITH JOHN EDWARDS |
| Credential | PH.D. |
| Practice Address |
12625 La Mirada Blvd Suite 202 La Mirada CA 90638-2211 |
| Mailing Address |
3005 Gotera Dr Hacienda Heights CA 91745-6613 |
| Practice Telephone | 5629034800 |
| Practice Fax Number | 5629034802 |
| Mailing Telephone | 6269687075 |
| Mailing Fax Number | 5629034864 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY10082 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922117894 | Keith C. Edwards | Radiology | 9300 Campus Point Dr., Ucsd Thornton Hospital Radiology, La Jolla, CA 92037-7756 | 2006-08-30 |
| 1093718371 | Keith Robert Edwards | Psychiatry & Neurology | 1205 Troy Schenectady Rd, Suite 105, Latham, NY 12110-1074 | 2005-05-31 |
| 1083716989 | Keith Owen Edwards | Dentist | 3680 Neuse Blvd, New Bern, NC 28560 | 2006-09-01 |
| 1881611846 | Keith Sylvester Edwards | Internal Medicine | 105 Stevens Ave, Suite 404, Mount Vernon, NY 10550-2686 | 2006-07-16 |
| Street Address |
12625 LA MIRADA BLVD SUITE 202 |
| City | LA MIRADA |
| State | CA |
| Zip Code | 90638-2211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184846164 | Miriam Elizabeth Lewis Hall | Psychologist | 12625 La Mirada Blvd, Suite 202, La Mirada, CA 90638-2211 | 2007-05-02 |
| 1679960918 | John Poston | Psychologist | 12625 La Mirada Blvd, Biola Counseling Center, La Mirada, CA 90638-2211 | 2015-04-24 |
| 1619210390 | Crystal Bowlby | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1205179884 | Todd W Hall | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1598008245 | Besty A Barber | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1972846657 | Nancy Crawford | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1134462815 | Jacqueline Gattis | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1023382025 | James Michael Woody | Psychologist | 12625 La Mirada Blvd, Suite 202, La Mirada, CA 90638 | 2012-03-08 |
| 1245559574 | Amy Rose Verbonich | Counselor | 12625 La Mirada Blvd, La Mirada, CA 90638-2211 | 2010-05-26 |
| 1164669396 | Laura K Pedigo | Psychologist | 12625 La Mirada Blvd, Suite 202, La Mirada, CA 90639-0001 | 2009-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972144095 | Amanda Connell | Counselor | 13710 La Mirada Blvd., Straight Talk, La Mirada, CA 90638 | 2019-09-30 |
| 1679054894 | James Kim | Occupational Therapist | 11926 La Mirada Blvd., La Mirada, CA 90638 | 2018-08-25 |
| 1780163915 | Complete Spine and Joint Center Inc | Chiropractor | 15112 Rosecrans Ave, La Mirada, CA 90638 | 2018-08-08 |
| 1124520606 | Meredith Narcisse | Counselor | Aegis Treatment Center 14240 Imperial Hwy, La Mirida, CA 90638 | 2018-03-01 |
| 1336685114 | Dorina Hamilton | Counselor | 14240 E. Imperial Hwy., La Mirada, CA 90638 | 2017-01-17 |
| 1497201768 | Blm Pharmacy Inc | Pharmacy | 12675 La Mirada Blvd., Suite 100, La Mirada, CA 90638 | 2016-08-28 |
| 1972954535 | Wendy Tran | Dentist | 12265 La Mirada Blvd, La Mirada, CA 90638 | 2016-06-24 |
| 1962851410 | Amy Bender | Counselor | 14240 Imperial Highway, La Mirada, CA 90638 | 2016-06-06 |
| 1699137430 | Andrea Lauren Smith | Chiropractor | 15651 East Imperial Hwy Ste 100, La Mirada, CA 90638 | 2016-03-22 |
| 1750797098 | Napoleon Tiquia | General Practice | 12049 Hartdale Avenue, La Mirada, CA 90638 | 2014-07-08 |
| Find all providers in zip 90638 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497963029 | Nancy Sherman Duvall | Psychologist | 12625 La Mirada Blvd, # 202, Biola Counseling Center, La Mirada, CA 90638-2211 | 2007-05-18 |
| 1619180692 | David Cimbora | Psychologist | 12625 La Mirada Blvd Ste 202, Biola Counseling Center, La Mirada, CA 90638-2213 | 2007-05-07 |
| 1184846164 | Miriam Elizabeth Lewis Hall | Psychologist | 12625 La Mirada Blvd, Suite 202, La Mirada, CA 90638-2211 | 2007-05-02 |
| 1083081103 | Elisa Shepard | Psychologist | 12625 La Mirada Blvd Ste 202, La Mirada, CA 90638-2213 | 2015-08-24 |
| 1619210390 | Crystal Bowlby | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1205179884 | Todd W Hall | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1598008245 | Besty A Barber | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1972846657 | Nancy Crawford | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1134462815 | Jacqueline Gattis | Psychologist | 12625 La Mirada Blvd, 202, La Mirada, CA 90638-2211 | 2013-04-01 |
| 1023382025 | James Michael Woody | Psychologist | 12625 La Mirada Blvd, Suite 202, La Mirada, CA 90638 | 2012-03-08 |
| Find all providers in LA MIRADA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.