Provider Demographics
NPI:1235021346
Name:EDINGER MEDICAL GROUP NB
Entity type:Organization
Organization Name:EDINGER MEDICAL GROUP NB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBYLUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-965-2543
Mailing Address - Street 1:9900 TALBERT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-965-2551
Mailing Address - Fax:714-965-2500
Practice Address - Street 1:180 NEWPORT CENTER DR STE 265
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:714-965-2500
Practice Address - Fax:714-965-2593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDINGER MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-15
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty