Provider Demographics
NPI:1265698518
Name:OMEGA EDWARDS MD INC
Entity type:Organization
Organization Name:OMEGA EDWARDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMEGA
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-389-0099
Mailing Address - Street 1:3801 LAS POSAS RD
Mailing Address - Street 2:SUITE 106-B
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1427
Mailing Address - Country:US
Mailing Address - Phone:805-389-0099
Mailing Address - Fax:805-389-4884
Practice Address - Street 1:3801 LAS POSAS RD
Practice Address - Street 2:SUITE 106-B
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1427
Practice Address - Country:US
Practice Address - Phone:805-389-0099
Practice Address - Fax:805-389-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103607207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty