Individual
KATINA DENEEN EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2372 MORSE AVE # 1090, IRVINE, CA 92614-6234
(310) 345-0101
(949) 681-3501
Mailing address
27183 LASSO WAY, CORONA, CA 92883-6685
(310) 345-0101
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
744354
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95025093
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568810117
—
CA
Enumeration date
05/24/2016
Last updated
02/20/2024
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