1396935243 NPI number — PAUL H. NIEBERG, M.D. INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396935243 NPI number — PAUL H. NIEBERG, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL H. NIEBERG, 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:
1396935243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92822-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-996-1633
Provider Business Mailing Address Fax Number:
714-996-9267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 E GREEN ST STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-304-0782
Provider Business Practice Location Address Fax Number:
626-658-2848
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIEBERG
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-584-1341

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  A67350 , 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: 00A673500 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DB9540 . This is a "RAILROAD MEDICARE GROUP I" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1902909187 . This is a "INDIVIDUAL MEDICARE NPI N" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A673500 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00139012 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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