Healthcare Provider Details

I. General information

NPI: 1730187881
Provider Name (Legal Business Name): GARY MITCHELL FEINBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE SUITE 201
RIVERSIDE CA
92506
US

IV. Provider business mailing address

PO BOX 7270
MORENO VALLEY CA
92552-7270
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-1447
  • Fax: 951-788-1485
Mailing address:
  • Phone: 951-656-1500
  • Fax: 951-656-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG58691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: