Healthcare Provider Details

I. General information

NPI: 1831183383
Provider Name (Legal Business Name): JOHN S. EDELEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ALTARINDA RD STE 112
ORINDA CA
94563-2607
US

IV. Provider business mailing address

PO BOX 130
VACAVILLE CA
95696-0130
US

V. Phone/Fax

Practice location:
  • Phone: 707-718-5988
  • Fax:
Mailing address:
  • Phone: 707-718-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG26272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: