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General NPI Number Information
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NPI Number | 1548456825
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 1007 LIVE OAK BLVD STE A-1
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City | YUBA CITY
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State | CA
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Zip | 95991-3454
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Country | US
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Telephone | 530-673-3790
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Fax | 530-673-5642
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Provider Business Mailing Address
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Address Line | 1007 LIVE OAK BLVD STE A-1
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City | YUBA CITY
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State | CA
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Zip | 95991-3454
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Country | US
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Telephone | 530-673-3790
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Fax | 530-673-5642
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEON MELVIN EDELSTEIN
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Credential | M.D.
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Telephone | 530-673-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207ZI0100X
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Taxonomy Name | Immunopathology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 207ZP0213X
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Taxonomy Name | Pediatric Pathology Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 00A192080
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License Number State | CA
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Taxonomy #11
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 00A192080
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License Number State | CA
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