Provider Demographics
NPI:1366482960
Name:EDELMAN, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:EDELMAN
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 1:3521 LOMITA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5041
Mailing Address - Country:US
Mailing Address - Phone:310-534-9131
Mailing Address - Fax:310-534-9132
Practice Address - Street 1:23441 MADISON ST. #280
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4735
Practice Address - Country:US
Practice Address - Phone:310-373-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG518442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51844OtherMEDICAL BOARD OF CA
CA00G518441Medicaid
CAG51844OtherMEDICAL BOARD OF CA
CAG51844Medicare ID - Type Unspecified
CA00G518441Medicaid