Individual
EDWIN CHARLES BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3801 UNIVERSITY AVENUE, SUITE 400, RIVERSIDE, CA 92501
(951) 955-7108
Mailing address
3801 UNIVERSITY AVENUE, SUITE 400, RIVERSIDE, CA 92501
(951) 955-7108
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
104100000X
CA
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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