Healthcare Provider Details

I. General information

NPI: 1437184629
Provider Name (Legal Business Name): ARYEH EDELIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #214,365,530,420,120
LOS ANGELES CA
90095
US

IV. Provider business mailing address

FILE #55737
LOS ANGELES CA
90074
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0631
  • Fax:
Mailing address:
  • Phone: 310-301-8708
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA22734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: