Provider Demographics
NPI:1023177870
Name:EDELSTEIN, LEON MELVIN (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:MELVIN
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 LIVE OAK BLVD
Mailing Address - Street 2:STE A-1
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3454
Mailing Address - Country:US
Mailing Address - Phone:530-673-3790
Mailing Address - Fax:530-673-5642
Practice Address - Street 1:1007 LIVE OAK BLVD
Practice Address - Street 2:STE A-1
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3454
Practice Address - Country:US
Practice Address - Phone:530-673-3790
Practice Address - Fax:530-673-5642
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A192080207K00000X, 207N00000X, 207ND0900X, 207NP0225X, 207NS0135X, 207ZD0900X, 207ZI0100X, 207ZP0102X, 207ZP0213X, 208D00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A192080Medicaid
CA756071401OtherRAILROAD MEDICARE
CA94-2606006OtherTAX ID#
CAZZZ29262ZMedicare ID - Type Unspecified
CA00A192080Medicaid