1194760025 NPI number — GAIL D FEINBERG DO

Table of content: GAIL D FEINBERG DO (NPI 1194760025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194760025 NPI number — GAIL D FEINBERG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEINBERG
Provider First Name:
GAIL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194760025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94592-1187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-638-5306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 E MONTE VISTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95688-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-469-4640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A15042 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000206067 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000643168 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00707430 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000606888 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6402221 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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