Provider Demographics
NPI:1386065803
Name:EDWARDS, IAN (CMP)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4009
Mailing Address - Country:US
Mailing Address - Phone:831-915-7757
Mailing Address - Fax:
Practice Address - Street 1:225 LIGHTHOUSE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1429
Practice Address - Country:US
Practice Address - Phone:831-915-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist