Healthcare Provider Details

I. General information

NPI: 1700856713
Provider Name (Legal Business Name): WADE FAERBER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40949 WINCHESTER RD
TEMECULA CA
92591-6031
US

IV. Provider business mailing address

PO BOX 1007
MURRIETA CA
92564-1007
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-6676
  • Fax:
Mailing address:
  • Phone: 951-696-9061
  • Fax: 951-696-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number20A6291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: