Provider Demographics
NPI:1417358631
Name:EDANG, ARMANDO (RN)
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:EDANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 VENADO WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:626-960-6500
Mailing Address - Fax:626-960-4500
Practice Address - Street 1:926 VENADO WAY
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4317
Practice Address - Country:US
Practice Address - Phone:626-960-6500
Practice Address - Fax:626-960-4500
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578025163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse