Organization
W ALLAN EDMISTON MD A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY D BIGGLES (DIRECTOR OF BUSINESS AND FINANCE)
(626) 793-1227
Entity
Organization
Contact information
Practice address
55 E CALIFORNIA BLVD FL 3, PASADENA, CA 91105-3944
(626) 793-1227
(626) 793-3794
Mailing address
55 E CALIFORNIA BLVD FL 3, PASADENA, CA 91105-3944
(626) 793-1227
(626) 793-3794
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G23064
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G23064
STATE LIC
CA
Enumeration date
07/31/2014
Last updated
11/20/2014
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