Organization Active NPI

Ronald J. Edelson MD a Medical Corporation

  • Plastic Surgery Physician
  • San Diego, CA
National Provider Identifier
1568760288
Registry record updated Mar 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
G59765 Issued in CA
Legal business name
RONALD J. EDELSON MD A MEDICAL CORPORATION
Practice address
9339 Genesee Ave Ste P39
San Diego, CA 92121-2120
Phone
(858) 452-9900
Fax
(858) 750-1474
NPI assigned
Mar 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ronald J Edelson, M.D.
Title
President
Phone
(858) 452-9900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X G59765 CA Primary

Addresses

Primary practice location

9339 Genesee Ave Ste P39
San Diego, CA 92121-2120

Mailing address

9339 Genesee Ave Ste P39
San Diego, CA 92121-2120
Phone (858) 452-9900

Other identifiers 1

IdentifierTypeStateIssuer
C2036558OtherCACORPORATION NUMBER

National Provider Directory

National Provider Directory

Locations

9339 Genesee Ave
Ste P39
San Diego, CA 92121
Phone (858) 452-9900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1568760288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9339 GENESEE AVE STE P39",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212120",
            "telephone_number": "858-452-9900",
            "fax_number": "858-750-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9339 GENESEE AVE STE P39",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212120",
            "telephone_number": "858-452-9900",
            "fax_number": "858-750-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD J. EDELSON MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-03",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "EDELSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-452-9900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G59765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION NUMBER",
            "identifier": "C2036558",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.