Fredric L Edelman MD a Prof Corp

Primary specialty

SpecialistTaxonomy code 174400000X

License

G15613 Issued in CA

Legal business name

FREDRIC L EDELMAN MD A PROF CORP

Practice address

16830 Ventura Blvd Ste 130
Encino, CA 91436-1786

Phone

(818) 781-3350

Fax

(818) 781-7237

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Cheryl Aguilera

Title

Manager

Phone

(818) 781-3350

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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

• Tirso Del Junco Jr., MD

  • Surgery Physician
  • Panorama City, CA
  • NPI 1306811625
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1952582249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16830 VENTURA BLVD STE 130",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361786",
            "telephone_number": "818-781-3350",
            "fax_number": "818-781-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16830 VENTURA BLVD STE 130",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361786",
            "telephone_number": "818-781-3350",
            "fax_number": "818-781-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDRIC L EDELMAN MD A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "AGUILERA",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-781-3350",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G15613",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G15613",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Frankel
• Bonnie K. Franklin, M.F.T.
• Jennifer Ann Franklin, M.A., SLP
• Sincere Najanaye Franks
• Fredric E Weiss Inc
• Freedom Vision Surgery Center LLC
• Darren Keith Freeman, D.O.
• Matthew Bret Freeman, LAC
• Katherine Nicole Frees
• Jared Freilich, BCBA

• Specialist in Encino, CA
• Providers in Encino, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.