MARY EDEM (NPI# 1760787030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760787030 |
| Entity Type | Individual |
| Full Name | MARY EDEM |
| Credential | NP |
| Practice Address |
190 E Highland Ave San Bernardino CA 92404-3658 |
| Mailing Address |
200 Oceangate Suite 100 Long Beach CA 90802-4317 |
| Practice Telephone | 9098824788 |
| Practice Fax Number | 8778607268 |
| Mailing Telephone | 5624996191 |
| Mailing Fax Number | 5624996171 |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2016-09-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
20107 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
190 E HIGHLAND AVE |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92404-3658 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699717306 | Renato G Rada | Family Medicine | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2006-06-10 |
| 1205393238 | Unicare Community Health Center Inc | Clinic/Center | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2019-02-26 |
| 1720465206 | Joseph M Molina Md Professional Corporation Southern California | Non-Pharmacy Dispensing Site | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2015-05-04 |
| 1972875680 | Joseph M Molina Md Professional Corporation-southern California | Pediatrics | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2012-01-27 |
| 1922237916 | Roshanda Clemons | Pediatrics | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2009-07-10 |
| 1568691293 | Ngoc Thi Bich Nguyen | Pediatrics | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2009-07-01 |
| 1811012636 | Gloria Elsie Morrow | Psychologist | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2007-03-20 |
| 1972651289 | Maria Elena Terrazas | Physician Assistant | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2007-01-05 |
| 1861507006 | Molina Healthcare of California | Internal Medicine | 190 E Highland Ave, San Bernardino, CA 92404-3658 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740849363 | Danniella Alexandra Murillo | Physician Assistant | 2101 North Waterman Ave, San Bernardino, CA 92404 | 2019-06-07 |
| 1902377484 | Shauntel Renee Nelson | Student in an Organized Health Care Education/Training Program | 1481 N. Windsor Dr., San Bernardino, CA 92404 | 2018-12-10 |
| 1487123584 | Garrett M Grigg | Licensed Psychiatric Technician | 1481 N Windsor Dr, San Bernardino, CA 92404 | 2018-11-19 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1043703564 | Samantha Makpaiboonvatana | Optometrist | 1909 N Waterman Ave Ste 3, San Bernardino, CA 92404 | 2018-06-09 |
| 1861981623 | Christopher Windham | Behavior Technician | 2460 Fremontia Dr, San Bernardino, CA 92404 | 2018-05-08 |
| 1891145041 | Cynthia Lusy Gastelum | Marriage & Family Therapist | 1885 E Lynwood Dr Rm Se3, San Bernardino, CA 92404 | 2016-06-20 |
| 1336598259 | Foundation Enterprises LLC | Non-emergency Medical Transport (VAN) | 1663 Date Pl., #30390, San Bernardino, CA 92404 | 2016-06-10 |
| 1881042877 | Helen Ann Thompson | Speech-Language Pathologist | 1311 E. State St., San Bernardo, CA 92404 | 2016-05-31 |
| 1366839938 | Lanecia Richardson | Counselor | 135 Paul Drive, San Rafeal, CA 92404 | 2015-04-22 |
| Find all providers in zip 92404 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003280934 | Brenda Boyle | Nurse Practitioner | 1455 East 3rd Street, San Bernardino, CA 92410 | 2015-11-16 |
| 1407494750 | Joshua Joseph Masih | Nurse Practitioner | 250 S G St, San Bernardino, CA 92410-3320 | 2019-12-17 |
| 1154964849 | Oyebola Omofadeke Oyelade | Nurse Practitioner | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2019-10-25 |
| 1104467190 | Karin Cecilia Ulltjaern | Nurse Practitioner | 250 S G St, San Bernardino, CA 92410-3320 | 2019-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154573 | Marcus Jang | Nurse Practitioner | 1130 E Colorado St Apt 214, Glendale, CA 91205-2092 | 2020-11-04 |
| 1033718580 | John Sylvanus Allieu Sr. | Nurse Practitioner | 2672 Merganser Ct, Los Banos, CA 93635-9473 | 2020-10-25 |
| 1316546930 | Chika U Oguagha | Nurse Practitioner | 16240 Carmine St, Fontana, CA 92336-1481 | 2020-10-23 |
| 1215534888 | Rosa Maria Aguero | Nurse Practitioner | 9841 Alburtis Ave Unit 29, Santa Fe Springs, CA 90670-3264 | 2020-10-06 |
| 1134726995 | Margarita Maghtesyan | Nurse Practitioner | 20251 Ventura Blvd Ste A, Woodland Hills, CA 91364-2564 | 2020-10-05 |
| 1043827140 | April Lopez Ortiz | Nurse Practitioner | 500 W Ashland Ct, Visalia, CA 93277-6609 | 2020-09-23 |
| 1477167666 | David Joseph Russell | Nurse Practitioner | 17846 Glenwood Rd, Manteca, CA 95336-9521 | 2020-09-03 |
| 1194339382 | Albert Liu | Nurse Practitioner | 43559 Southerland Way, Fremont, CA 94539-5931 | 2020-09-03 |
| 1407469554 | Andre Alexandrian | Nurse Practitioner | 1606 Winona Ave, Burbank, CA 91504-2823 | 2020-08-28 |
| 1790398238 | Heather Richardson | Nurse Practitioner | 112 S Park St Ste 1, San Francisco, CA 94107-1809 | 2020-08-25 |
| Find all providers with the same taxonomy | ||||
| City | SAN BERNARDINO |
| Zip Code | 92404 |
Please comment or provide details below to improve the information on MARY EDEM.
| 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.