Healthcare Provider Details

I. General information

NPI: 1346342995
Provider Name (Legal Business Name): CLIFFORD G. FEAVER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15025 INNOVATION DR
SAN DIEGO CA
92128-3409
US

IV. Provider business mailing address

FILE 54433
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-605-7973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: