Provider Demographics
NPI:1730913021
Name:CONCEPCION, EDGAR R (RN)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:R
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:RN
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 1603
Mailing Address - Street 2:
Mailing Address - City:INYOKERN
Mailing Address - State:CA
Mailing Address - Zip Code:93527-1603
Mailing Address - Country:US
Mailing Address - Phone:407-373-3377
Mailing Address - Fax:
Practice Address - Street 1:1141 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3208
Practice Address - Country:US
Practice Address - Phone:760-463-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95295667163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health