1770514945 NPI number — ALAN E. GORENBERG MD, INC.

Table of content: (NPI 1770514945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770514945 NPI number — ALAN E. GORENBERG MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN E. GORENBERG MD, 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:
6
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:
1770514945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8506 E CHAPMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92869-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-633-4666
Provider Business Mailing Address Fax Number:
714-633-4640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8506 E CHAPMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92869-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-633-4666
Provider Business Practice Location Address Fax Number:
714-633-4640
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GORENBERG
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-633-4666

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G60876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207KA0200X , with the licence number: G60876 , 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: 1730115221 . This is a "NPI (INDIVIDUAL)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1770514945 . This is a "NPI (INCORPERATED)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G60876 . This is a "MEDICAL LIC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".