Provider Demographics
NPI:1932173713
Name:EDWARDS, TINA FORTHUN (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:FORTHUN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:FORTHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2125 S EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6260
Mailing Address - Country:US
Mailing Address - Phone:760-425-4466
Mailing Address - Fax:
Practice Address - Street 1:2125 S EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-425-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93271207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine