Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 00A192080 | CA |
N | 207N00000X | Dermatologist | 00A192080 | CA |
Y | 207ND0900X | Dermatopathologist | 00A192080 | CA |
N | 207NP0225X | Pediatric Dermatologist | 00A192080 | CA |
N | 207NS0135X | Procedural Dermatology | 00A192080 | CA |
N | 208D00000X | General Practice Physician | 00A192080 | CA |
NPI | 1023177870 |
---|---|
Provider Name | Dr. Leon Melvin Edelstein |
First Address | Yuba City, CA 95991-3454 |
Second Address | Yuba City, CA 95991-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A192080 | (05) | CA |
756071401 | RAILROAD MEDICARE (01) | CA |
94-2606006 | TAX ID# (01) | CA |
A21651 | (02) | CA |