Healthcare Provider Details

I. General information

NPI: 1730270331
Provider Name (Legal Business Name): MYRA LEE FEFFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343-2036
US

IV. Provider business mailing address

2670 BASIL LN
LOS ANGELES CA
90077-2006
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax:
Mailing address:
  • Phone: 310-470-8878
  • Fax: 310-470-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberGI2306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: