Individual
CHARLES S EDWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1225 WILSHIRE BLVD, LOS ANGELES, CA 90017-1901
(213) 977-2121
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(213) 977-2121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002691
CT
363A00000X
Physician Assistant
Primary
PA22163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA22163
MEDICAL LICENSE
CA
Enumeration date
12/19/2011
Last updated
02/22/2023
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