Provider Demographics
NPI:1528279387
Name:EDMOND, REGINA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LOUISE
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0256
Mailing Address - Country:US
Mailing Address - Phone:323-776-3890
Mailing Address - Fax:323-686-5119
Practice Address - Street 1:1950 SAWTELLE BLVD STE 145
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7074
Practice Address - Country:US
Practice Address - Phone:310-575-4050
Practice Address - Fax:310-575-4250
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91799207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology