Healthcare Provider Details

I. General information

NPI: 1427294842
Provider Name (Legal Business Name): DAVID A EDELSOHN MD INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 WEST GRANTLINE ROAD TRACY SURGERY CENTER SUITE 120
TRACY CA
95377-7330
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 209-836-5680
  • Fax: 209-836-5778
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA037480
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID A EDELSOHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-604-6136