Individual
EDWARD A MCCLUSKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4475
(909) 558-0187
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
G70496
CA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
G70496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1109156
—
WA
01
—
11132427
CAQH
—
01
—
57195
CAREOREGON
OR
01
—
808594001
REGENCE
—
01
—
O132758
LABOR & IND
WA
01
—
O50073107
RR MEDICARE
—
05
—
O57195
—
OR
Enumeration date
01/30/2006
Last updated
09/22/2023
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