Healthcare Provider Details

I. General information

NPI: 1831364769
Provider Name (Legal Business Name): JOANNE FELDMAN,M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ANTONIO AVE
CAMARILLO CA
93010-1414
US

IV. Provider business mailing address

PO BOX 4125
MALIBU CA
90264-4125
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-5800
  • Fax:
Mailing address:
  • Phone: 619-258-6200
  • Fax: 619-258-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberA88786
License Number StateCA

VIII. Authorized Official

Name: DR. JOANNE FELDMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-258-6200