Healthcare Provider Details

I. General information

NPI: 1164568655
Provider Name (Legal Business Name): DANE R FLIEDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DOVE ST SUITE 276
NEWPORT BEACH CA
92660-2433
US

IV. Provider business mailing address

PO BOX 12257
NEWPORT BEACH CA
92658-5057
US

V. Phone/Fax

Practice location:
  • Phone: 949-788-1111
  • Fax: 949-788-1110
Mailing address:
  • Phone: 949-788-1111
  • Fax: 949-788-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5161
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: