Healthcare Provider Details

I. General information

NPI: 1366557910
Provider Name (Legal Business Name): GARY M. FEINBERG, MD, FACS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 BROCKTON AVE SUITE 3
RIVERSIDE CA
92506-3831
US

IV. Provider business mailing address

6950 BROCKTON AVE SUITE 3
RIVERSIDE CA
92506-3831
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-1447
  • Fax: 951-788-1485
Mailing address:
  • Phone: 951-788-1447
  • Fax: 951-788-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG58691
License Number StateCA

VIII. Authorized Official

Name: MR. GARY MITCHELL FEINBERG
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 951-788-1447