Healthcare Provider Details

I. General information

NPI: 1467607077
Provider Name (Legal Business Name): DEREK NAEGLE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2615
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-321-6365
  • Fax: 951-784-3264
Mailing address:
  • Phone: 951-321-6365
  • Fax: 951-784-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number510657874
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: