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General NPI Number Information
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NPI Number | 1295098283
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Entity Type | Individual
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Provider Name | INGRID EDSHTEYN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2012
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLAZA SUTIE 365,420,120
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City | LOS ANGELES
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State | CA
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Zip | 90024-0001
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Country | US
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Telephone | 310-825-8173
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-301-8713
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Fax | 310-301-8751
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 20A15899
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License Number State | CA
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