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: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST SUITE 400
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

701 E 28TH ST SUITE 400
LONG BEACH CA
90806-2759
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-9929
  • Fax: 562-427-2565
Mailing address:
  • Phone: 562-427-9929
  • Fax: 562-427-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG48000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: