=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295815280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER S BIRNBAUM DO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 02/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 W LA PALMA AVE STE 506
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-491-3670
-----------------------------------------------------
Fax | 714-533-6760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1211 W LA PALMA AVE STE 506
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-491-3670
-----------------------------------------------------
Fax | 714-533-6760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | PETER S BIRNBAUM
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 714-491-3670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------