Basic Information
| Provider Information | |||||||||
| NPI: | 1396107017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDGCOMB | ||||||||
| FirstName: | JULIET | ||||||||
| MiddleName: | BENI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD PHD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BENI | ||||||||
| OtherFirstName: | JULIET | ||||||||
| OtherMiddleName: | BEATRICE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | UCLA SEMEL INSTITUTE FOR NEUROSCIENCE & HUMAN BEHAVIOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108254321 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | UCLA SEMEL INSTITUTE FOR NEUROSCIENCE & HUMAN BEHAVIOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108254321 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A153003 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.