Healthcare Provider Details

I. General information

NPI: 1053467738
Provider Name (Legal Business Name): DAVID FEIFEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT STE 112
LA JOLLA CA
92037-1808
US

IV. Provider business mailing address

3252 HOLIDAY CT STE 112
LA JOLLA CA
92037-1808
US

V. Phone/Fax

Practice location:
  • Phone: 858-412-4130
  • Fax: 858-412-5088
Mailing address:
  • Phone: 858-412-4130
  • Fax: 858-412-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA51236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: