Healthcare Provider Details

I. General information

NPI: 1972785889
Provider Name (Legal Business Name): WADE FAERBER D.O., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
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: 951-696-9061
  • Fax: 951-696-9262
Mailing address:
  • Phone: 951-696-9061
  • Fax: 951-696-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20A6291
License Number StateCA

VIII. Authorized Official

Name: WADE FAERBER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 951-296-6676