Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G15613 | CA |
NPI | 1063514271 |
---|---|
Provider Name | Fredric L Edelman |
First Address | Sherman Oaks, CA 91403-2137 |
Second Address | Sherman Oaks, CA 91403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 03/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G156130 | (05) | CA |
A39575 | (02) | |
GR0079310 | (05) | CA |