Provider Demographics
NPI:1619001427
Name:EDEZA, IFRAEL JR
Entity type:Individual
Prefix:
First Name:IFRAEL
Middle Name:
Last Name:EDEZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951-B BLANCO CIRLCE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-755-4291
Mailing Address - Fax:831-796-2820
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:ROOM 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3122
Practice Address - Country:US
Practice Address - Phone:831-755-4291
Practice Address - Fax:831-796-2820
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor