Healthcare Provider Details

I. General information

NPI: 1194822262
Provider Name (Legal Business Name): LESLIE HOWARD EDRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 125
LONG BEACH CA
90806-7500
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 125
LONG BEACH CA
90806-7500
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3136
  • Fax: 562-933-8964
Mailing address:
  • Phone: 562-933-3136
  • Fax: 562-933-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG48000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: