Healthcare Provider Details

I. General information

NPI: 1730759754
Provider Name (Legal Business Name): JEFFREY FELGNER MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 ORANGE AVE
COSTA MESA CA
92627-2238
US

IV. Provider business mailing address

1998 ORANGE AVE
COSTA MESA CA
92627-2238
US

V. Phone/Fax

Practice location:
  • Phone: 858-735-6258
  • Fax:
Mailing address:
  • Phone: 858-735-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY STEVEN FELGNER
Title or Position: OWNER
Credential: MD
Phone: 858-735-6258