Individual
EDVINA SAMKELISO FUYANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17981 SKY PARK CIR BLDG 39, IRVINE, CA 92614-6309
(877) 896-7350
Mailing address
17981 SKY PARK CIR BLDG 39, IRVINE, CA 92614-6309
(877) 896-7350
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
95017106
CA
363LF0000X
Family Nurse Practitioner
Primary
213866
GA
Other
Enumeration date
05/11/2021
Last updated
01/12/2022
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