Individual
DR. MARK DAVID EDELSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1933 9TH AVE, SACRAMENTO, CA 95818-4214
(916) 442-4682
Mailing address
1933 9TH AVE, SACRAMENTO, CA 95818-4214
(916) 442-4682
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
C41340
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C41340(0)
MEDI-CAL PIN
CA
01
—
1177
SACRAMENTO CY. PROVIDER #
CA
01
—
1238
SAN JOAQUIN COUNTY MENTAL HEALTH DEPT.
CA
Enumeration date
08/14/2006
Last updated
03/20/2012
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