1295048486 NPI number — IRA E FELMAN MD

Table of content: (NPI 1295048486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295048486 NPI number — IRA E FELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRA E FELMAN MD
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:
SAN GABRIEL VALLEY ONCOLOGY CENTER
Provider Other Organization Name Type Code:
3
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:
1295048486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 N. 4TH STREET
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-725-1700
Provider Business Mailing Address Fax Number:
323-725-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 N. 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-725-1700
Provider Business Practice Location Address Fax Number:
323-725-1725
Provider Enumeration Date:
07/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FELMAN
Authorized Official First Name:
IRA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-725-1700

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G37852 , 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: 3302766 . This is a "ARTICLES OF INCORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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