Provider Demographics
NPI:1316063837
Name:EDELSTEIN, ROSE A (LVN)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:A
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 COLDWATER CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1112
Mailing Address - Country:US
Mailing Address - Phone:818-623-6300
Mailing Address - Fax:
Practice Address - Street 1:6455 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1112
Practice Address - Country:US
Practice Address - Phone:818-623-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 69111164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN 69111OtherLVN LICENSE