Healthcare Provider Details

I. General information

NPI: 1568404572
Provider Name (Legal Business Name): MITCHELL L FEINGOLD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 6TH AVE
SAN DIEGO CA
92101-1643
US

IV. Provider business mailing address

5580 LA JOLLA BLVD #419
LA JOLLA CA
92037-7651
US

V. Phone/Fax

Practice location:
  • Phone: 858-550-8110
  • Fax: 858-550-8087
Mailing address:
  • Phone: 858-550-8110
  • Fax: 858-550-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE-1436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: