Healthcare Provider Details

I. General information

NPI: 1740207737
Provider Name (Legal Business Name): CARY EDWARD FEIBLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST STE 218
SAN LEANDRO CA
94578-2626
US

IV. Provider business mailing address

701 E 28TH STREET SUITE 311
LONG BEACH CA
90806-2780
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-0312
  • Fax: 510-483-5864
Mailing address:
  • Phone: 562-595-4777
  • Fax: 562-424-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG40658
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG40658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: