1639237043 NPI number — DAVID E FELDMAN, M.D., INC.

Table of content: (NPI 1639237043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639237043 NPI number — DAVID E FELDMAN, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID E FELDMAN, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639237043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93062-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-522-5940
Provider Business Mailing Address Fax Number:
805-522-6401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-832-3311
Provider Business Practice Location Address Fax Number:
310-514-5204
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FELDMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-832-3311

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ50198Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0103940 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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