Healthcare Provider Details

I. General information

NPI: 1760045504
Provider Name (Legal Business Name): SAMUEL ROSS DONNENFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

1642 7TH AVE UNIT 523
SAN DIEGO CA
92101-2755
US

V. Phone/Fax

Practice location:
  • Phone: 91-232-7106
  • Fax:
Mailing address:
  • Phone: 610-937-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA202659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: