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General NPI Number Information
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NPI Number | 1275622094
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Entity Type | Individual
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Provider Name | MICHAEL MARVIN EDELSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 3460 RIDGEFORD DR
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-4818
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Country | US
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Telephone | 818-707-9778
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Fax | 818-874-3655
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Provider Business Mailing Address
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Address Line | 3460 RIDGEFORD DR
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-4818
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Country | US
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Telephone | 818-707-9778
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Fax | 818-874-3655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G009107
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License Number State | CA
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