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General NPI Number Information
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NPI Number | 1568760288
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Entity Type | Organization
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Legal Business Name | RONALD J. EDELSON MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 9339 GENESEE AVE STE P39
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City | SAN DIEGO
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State | CA
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Zip | 92121-2120
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Country | US
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Telephone | 858-452-9900
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Fax | 858-750-1474
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Provider Business Mailing Address
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Address Line | 9339 GENESEE AVE STE P39
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City | SAN DIEGO
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State | CA
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Zip | 92121-2120
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Country | US
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Telephone | 858-452-9900
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Fax | 858-750-1474
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD J EDELSON
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Credential | M.D.
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Telephone | 858-452-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G59765
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License Number State | CA
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