Provider Demographics
NPI:1215062310
Name:EDWARDS, WHITNEY C (MD)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2213
Mailing Address - Country:US
Mailing Address - Phone:619-297-5437
Mailing Address - Fax:
Practice Address - Street 1:550 WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2213
Practice Address - Country:US
Practice Address - Phone:619-297-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG835980174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0045532OtherMEDI-CAL
CA330831376 92103 B001OtherTRICARE
CAZZZ02551ZOtherBLUE SHIELD