Healthcare Provider Details

I. General information

NPI: 1497941215
Provider Name (Legal Business Name): IRINA FELDMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROLLING OAKS DR STE 204
THOUSAND OAKS CA
91361-1285
US

IV. Provider business mailing address

351 ROLLING OAKS DR STE 204
THOUSAND OAKS CA
91361-1285
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-7676
  • Fax: 805-374-1323
Mailing address:
  • Phone: 805-777-7676
  • Fax: 805-374-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA88266
License Number StateCA

VIII. Authorized Official

Name: IRINA FELDMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-777-7676