Healthcare Provider Details

I. General information

NPI: 1730359647
Provider Name (Legal Business Name): DONNA P EISENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W ORANGEWOOD AVE SUITE I
ORANGE CA
92868-2040
US

IV. Provider business mailing address

PO BOX 9863
NEWPORT BEACH CA
92658-1863
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-8346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: