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General NPI Number Information
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NPI Number | 1093990665
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Entity Type | Organization
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Legal Business Name | PETER S. BIRNBAUM D.O. INC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 714-995-1531
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Fax | 714-995-8194
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Provider Business Mailing Address
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Address Line | 3010 W ORANGE AVE SUITE 403
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City | ANAHEIM
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State | CA
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Zip | 92804-3169
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Country | US
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Telephone | 714-995-1531
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Fax | 714-995-8194
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER S BIRNBAUM
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Credential | DO
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Telephone | 714-995-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20A7133
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License Number State | CA
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