Provider Demographics
NPI:1902917321
Name:EDGARDO A FALCON MD, INC.
Entity Type:Organization
Organization Name:EDGARDO A FALCON MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-278-7888
Mailing Address - Street 1:115 VIENTOS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1602
Mailing Address - Country:US
Mailing Address - Phone:805-278-7888
Mailing Address - Fax:805-484-2497
Practice Address - Street 1:115 VIENTOS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1602
Practice Address - Country:US
Practice Address - Phone:805-278-7888
Practice Address - Fax:805-484-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31579282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417992561Other
CA1417992561Other510565371